Original Article
Gamma knife pallidotomy for treatment of Parkinson’s disease: long term results, clinical study
Abstract
Background: Deep brain stimulation (DBS) is now the preferred surgical treatment for advanced Parkinson’s disease (PD). Some patients however are not suitable candidates for an open surgical procedure or may prefer a procedure that does not include the permanent implantation of hardware. For such patients, gamma knife pallidotomy (GKP) may be a suitable alternative.
Objective: The goal of this report was to describe the safety and effectiveness of posteroventral pallidotomy (GKP) performed with the Leksell gamma knife (LGK) for the treatment of advanced PD.
Methods: Forty patients underwent a total of 51 GKP procedures with LGK between August 1993 and June 2009. Twenty nine patients underwent a unilateral procedure whereas 11 underwent bilateral procedures.
Results: There were statistically significant improvements in off-medication unified Parkinson’s disease rating scale (UPDRS) scores for total scores (18.4%), motor scores (18.2%), tremor(72.4%) rigidity (51.2%) and bradykinesia (23.4%) scores and also for on medication dyskinesia scores (70.0%.) Bilateral procedures produced an additional incremental improvement in symptoms. Two patients suffered permanent complications.
Conclusions: GKP offers a safe and effective procedure for the treatment of advanced PD. Although probably not as effective as DBS, it is particularly applicable to patients who may not be candidates for DBS.
Objective: The goal of this report was to describe the safety and effectiveness of posteroventral pallidotomy (GKP) performed with the Leksell gamma knife (LGK) for the treatment of advanced PD.
Methods: Forty patients underwent a total of 51 GKP procedures with LGK between August 1993 and June 2009. Twenty nine patients underwent a unilateral procedure whereas 11 underwent bilateral procedures.
Results: There were statistically significant improvements in off-medication unified Parkinson’s disease rating scale (UPDRS) scores for total scores (18.4%), motor scores (18.2%), tremor(72.4%) rigidity (51.2%) and bradykinesia (23.4%) scores and also for on medication dyskinesia scores (70.0%.) Bilateral procedures produced an additional incremental improvement in symptoms. Two patients suffered permanent complications.
Conclusions: GKP offers a safe and effective procedure for the treatment of advanced PD. Although probably not as effective as DBS, it is particularly applicable to patients who may not be candidates for DBS.
