´╗┐ Stereotactic Surgery for Movement Disorders | Neurosurgery | Dartmouth-Hitchcock
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Stereotactic Surgery for Movement Disorders

Introduction

Patients with movement disorders, such as Parkinson's disease, may have many different symptoms. The most common symptoms are shaking, muscle stiffness, and impaired voluntary movement. These symptoms have been linked to disturbances in the part of the brain that is in charge of movement. Medicine can help treat some of these symptoms, but for some patients, medicine is not enough.

There are three common surgical procedures that can help control the symptoms of movement disorders.

These procedures are:

  1. Pallidotomy
  2. Thalamotomy
  3. Deep Brain Stimulation

You will meet with specialized doctors to see if surgery is right for you. Through office visits and testing, your doctor will determine which surgery may best control your symptoms.

Pallidotomy

This operation involves creating a small lesion in a part of the brain called the globus pallidus.

The purpose of this procedure is to interrupt the nerve pathways through the pallidus. In doing so, this will help improve some movement disorder symptoms.

The most common benefits from this procedure include less shaking, less stiffness, and less bradykinesia (slow movements). The amount of benefit varies slightly with each patient.

Risks:

As with any surgical procedure there are risks involved. The chances of these risks are low, but do need to be discussed. The risks include infection (1-2%), stroke (1-2%), and problems with vision (as high as 16% in some reported series).

Thalamotomy

This procedure involves creating a small lesion in the thalamus of the brain. Thalamotomy has been most successful for treating shaking. Statistics show that 70 to 90% of patients have improvement in their symptoms.

As with the pallidotomy, the degree of benefit varies with each patient.

Globus Pallidus

Risks:

The most serious risks associated with this procedure include infection (1-2%) and stroke (1-2%).

Deep Brain Stimulation (DBS)

This operation involves placing an electrode in a part of the brain called the thalamus. An electrode is a special coated wire which sends an electrical signal. This electrode is one part of a three-part system that provides electrical stimulation to the thalamus. The system includes:

  1. The electrode
  2. A wire that is tunneled under the scalp to a site just below the collarbone
  3. A pulse generator

The purpose of this system is to reduce or eliminate tremor, stiffness, and slow movement. As with the other surgical procedures, the amount of benefit varies slightly with each patient.

Risks:

The risks associated with this surgery are similar to those of pallidotomy and thalamotomy. Unlike making a permanent cut in the brain tissue however, the stimulation may be turned off if undesirable side effects occur.


Page reviewed on: Mar 31, 2005

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