Surgical complications in patients with Parkinson's disease after posteroventral pallidotomy

Yoshinori Higuchi, Robert Paul Iacono, Kim Burchiel, Patrick J. Kelly, Roy A E Bakay, Jaimie M. Henderson, Ali R. Rezai, Andres M. Lozano

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

OBJECTIVE: To investigate the potential operative morbidity in posteroventral pallidotomy (PVP) for patients with Parkinson's disease. METHODS: We designed a retrospective study that included 796 consecutive patients (mean age, 64.9 yr; male, 559; female, 237) with Parkinson's disease. All PVPs (simultaneous bilateral PVP, n = 272; sequential bilateral PVP, n = 88; unilateral PVP, n = 436) were performed during a 7-year period. The total number of operations was 884, and the number of PVP procedures was 1156. In 108 patients, ventral intermediate nucleus thalamotomy was performed simultaneously. RESULTS: The overall complication rate, including temporary problems, was 15.3% of 884 operations. Permanent complications occurred in 3.6% of total operations. Intracranial hemorrhage occurred in 24 operations (2.7%). In seven of them, the patients required craniotomy and hematoma evacuation and sustained a disabling motor deficit (0.8%). Intracranial hemorrhage occurred more often in patients who underwent microelectrode recording and had a history of chronic hypertension. Hemiparesis without intracranial hematoma occurred in 12 operations (1.4%). Microelectrode recording was a risk factor for postoperative hemiparesis without hemorrhage. In 19 operations (2.1%), patients developed a partial visual field deficit. Speech disturbance after surgery was observed in 23 operations (2.6%) but resolved in 17 by 1 week after surgery. In 55 operations (6.2%), patients developed postoperative confusion. This occurred more often in elderly patients and those with advanced disease. In 17 operations (1.9%), patients required observation in the intensive care unit because of postoperative hypotension. CONCLUSION: Complications from stereotactic pallidotomy were not frequent. However, the residual symptoms from complications can be serious in many cases.

Original languageEnglish (US)
Pages (from-to)558-571
Number of pages14
JournalNeurosurgery
Volume52
Issue number3
StatePublished - Mar 1 2003
Externally publishedYes

Fingerprint

Pallidotomy
Parkinson Disease
Intracranial Hemorrhages
Microelectrodes
Paresis
Hematoma
Confusion
Craniotomy
Visual Fields
Hypotension
Intensive Care Units
Retrospective Studies
Observation
Hemorrhage

Keywords

  • Complications
  • Intracranial hemorrhage
  • Microelectrode recording
  • Parkinson's disease
  • Posteroventral pallidotomy
  • Risk factors

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Higuchi, Y., Iacono, R. P., Burchiel, K., Kelly, P. J., Bakay, R. A. E., Henderson, J. M., ... Lozano, A. M. (2003). Surgical complications in patients with Parkinson's disease after posteroventral pallidotomy. Neurosurgery, 52(3), 558-571.

Surgical complications in patients with Parkinson's disease after posteroventral pallidotomy. / Higuchi, Yoshinori; Iacono, Robert Paul; Burchiel, Kim; Kelly, Patrick J.; Bakay, Roy A E; Henderson, Jaimie M.; Rezai, Ali R.; Lozano, Andres M.

In: Neurosurgery, Vol. 52, No. 3, 01.03.2003, p. 558-571.

Research output: Contribution to journalArticle

Higuchi, Y, Iacono, RP, Burchiel, K, Kelly, PJ, Bakay, RAE, Henderson, JM, Rezai, AR & Lozano, AM 2003, 'Surgical complications in patients with Parkinson's disease after posteroventral pallidotomy', Neurosurgery, vol. 52, no. 3, pp. 558-571.
Higuchi Y, Iacono RP, Burchiel K, Kelly PJ, Bakay RAE, Henderson JM et al. Surgical complications in patients with Parkinson's disease after posteroventral pallidotomy. Neurosurgery. 2003 Mar 1;52(3):558-571.
Higuchi, Yoshinori ; Iacono, Robert Paul ; Burchiel, Kim ; Kelly, Patrick J. ; Bakay, Roy A E ; Henderson, Jaimie M. ; Rezai, Ali R. ; Lozano, Andres M. / Surgical complications in patients with Parkinson's disease after posteroventral pallidotomy. In: Neurosurgery. 2003 ; Vol. 52, No. 3. pp. 558-571.
@article{0e8ce6cff137499fa1cae8d8b0b91167,
title = "Surgical complications in patients with Parkinson's disease after posteroventral pallidotomy",
abstract = "OBJECTIVE: To investigate the potential operative morbidity in posteroventral pallidotomy (PVP) for patients with Parkinson's disease. METHODS: We designed a retrospective study that included 796 consecutive patients (mean age, 64.9 yr; male, 559; female, 237) with Parkinson's disease. All PVPs (simultaneous bilateral PVP, n = 272; sequential bilateral PVP, n = 88; unilateral PVP, n = 436) were performed during a 7-year period. The total number of operations was 884, and the number of PVP procedures was 1156. In 108 patients, ventral intermediate nucleus thalamotomy was performed simultaneously. RESULTS: The overall complication rate, including temporary problems, was 15.3{\%} of 884 operations. Permanent complications occurred in 3.6{\%} of total operations. Intracranial hemorrhage occurred in 24 operations (2.7{\%}). In seven of them, the patients required craniotomy and hematoma evacuation and sustained a disabling motor deficit (0.8{\%}). Intracranial hemorrhage occurred more often in patients who underwent microelectrode recording and had a history of chronic hypertension. Hemiparesis without intracranial hematoma occurred in 12 operations (1.4{\%}). Microelectrode recording was a risk factor for postoperative hemiparesis without hemorrhage. In 19 operations (2.1{\%}), patients developed a partial visual field deficit. Speech disturbance after surgery was observed in 23 operations (2.6{\%}) but resolved in 17 by 1 week after surgery. In 55 operations (6.2{\%}), patients developed postoperative confusion. This occurred more often in elderly patients and those with advanced disease. In 17 operations (1.9{\%}), patients required observation in the intensive care unit because of postoperative hypotension. CONCLUSION: Complications from stereotactic pallidotomy were not frequent. However, the residual symptoms from complications can be serious in many cases.",
keywords = "Complications, Intracranial hemorrhage, Microelectrode recording, Parkinson's disease, Posteroventral pallidotomy, Risk factors",
author = "Yoshinori Higuchi and Iacono, {Robert Paul} and Kim Burchiel and Kelly, {Patrick J.} and Bakay, {Roy A E} and Henderson, {Jaimie M.} and Rezai, {Ali R.} and Lozano, {Andres M.}",
year = "2003",
month = "3",
day = "1",
language = "English (US)",
volume = "52",
pages = "558--571",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Surgical complications in patients with Parkinson's disease after posteroventral pallidotomy

AU - Higuchi, Yoshinori

AU - Iacono, Robert Paul

AU - Burchiel, Kim

AU - Kelly, Patrick J.

AU - Bakay, Roy A E

AU - Henderson, Jaimie M.

AU - Rezai, Ali R.

AU - Lozano, Andres M.

PY - 2003/3/1

Y1 - 2003/3/1

N2 - OBJECTIVE: To investigate the potential operative morbidity in posteroventral pallidotomy (PVP) for patients with Parkinson's disease. METHODS: We designed a retrospective study that included 796 consecutive patients (mean age, 64.9 yr; male, 559; female, 237) with Parkinson's disease. All PVPs (simultaneous bilateral PVP, n = 272; sequential bilateral PVP, n = 88; unilateral PVP, n = 436) were performed during a 7-year period. The total number of operations was 884, and the number of PVP procedures was 1156. In 108 patients, ventral intermediate nucleus thalamotomy was performed simultaneously. RESULTS: The overall complication rate, including temporary problems, was 15.3% of 884 operations. Permanent complications occurred in 3.6% of total operations. Intracranial hemorrhage occurred in 24 operations (2.7%). In seven of them, the patients required craniotomy and hematoma evacuation and sustained a disabling motor deficit (0.8%). Intracranial hemorrhage occurred more often in patients who underwent microelectrode recording and had a history of chronic hypertension. Hemiparesis without intracranial hematoma occurred in 12 operations (1.4%). Microelectrode recording was a risk factor for postoperative hemiparesis without hemorrhage. In 19 operations (2.1%), patients developed a partial visual field deficit. Speech disturbance after surgery was observed in 23 operations (2.6%) but resolved in 17 by 1 week after surgery. In 55 operations (6.2%), patients developed postoperative confusion. This occurred more often in elderly patients and those with advanced disease. In 17 operations (1.9%), patients required observation in the intensive care unit because of postoperative hypotension. CONCLUSION: Complications from stereotactic pallidotomy were not frequent. However, the residual symptoms from complications can be serious in many cases.

AB - OBJECTIVE: To investigate the potential operative morbidity in posteroventral pallidotomy (PVP) for patients with Parkinson's disease. METHODS: We designed a retrospective study that included 796 consecutive patients (mean age, 64.9 yr; male, 559; female, 237) with Parkinson's disease. All PVPs (simultaneous bilateral PVP, n = 272; sequential bilateral PVP, n = 88; unilateral PVP, n = 436) were performed during a 7-year period. The total number of operations was 884, and the number of PVP procedures was 1156. In 108 patients, ventral intermediate nucleus thalamotomy was performed simultaneously. RESULTS: The overall complication rate, including temporary problems, was 15.3% of 884 operations. Permanent complications occurred in 3.6% of total operations. Intracranial hemorrhage occurred in 24 operations (2.7%). In seven of them, the patients required craniotomy and hematoma evacuation and sustained a disabling motor deficit (0.8%). Intracranial hemorrhage occurred more often in patients who underwent microelectrode recording and had a history of chronic hypertension. Hemiparesis without intracranial hematoma occurred in 12 operations (1.4%). Microelectrode recording was a risk factor for postoperative hemiparesis without hemorrhage. In 19 operations (2.1%), patients developed a partial visual field deficit. Speech disturbance after surgery was observed in 23 operations (2.6%) but resolved in 17 by 1 week after surgery. In 55 operations (6.2%), patients developed postoperative confusion. This occurred more often in elderly patients and those with advanced disease. In 17 operations (1.9%), patients required observation in the intensive care unit because of postoperative hypotension. CONCLUSION: Complications from stereotactic pallidotomy were not frequent. However, the residual symptoms from complications can be serious in many cases.

KW - Complications

KW - Intracranial hemorrhage

KW - Microelectrode recording

KW - Parkinson's disease

KW - Posteroventral pallidotomy

KW - Risk factors

UR - http://www.scopus.com/inward/record.url?scp=0037369884&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037369884&partnerID=8YFLogxK

M3 - Article

C2 - 12590680

AN - SCOPUS:0037369884

VL - 52

SP - 558

EP - 571

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 3

ER -