| Pallidotomy | |
|---|---|
 2 cross sections of thehuman brain, with theglobus pallidus in green. | |
| Specialty | Neurosurgery |
| ICD-9-CM | 01.42 |
| MeSH | D053860 |
Pallidotomy is aneurosurgical procedure. It is used to treatParkinson's disease and some other conditions, often as an alternative todeep brain stimulation. It involves placing a tiny electrical probe in theglobus pallidus, one of thebasal ganglia of thebrain, to damage it. Unilateral pallidotomy can cause side effects including problems with language learning, visuospatial constructional ability, andexecutive functions. Bilateral pallidotomy is not effective, with many severe side effects.
Theinternal globus pallidus can be regarded as an "output structure" of thebasal ganglia.[1] It processes input fromnucleus accumbens and thestriatum, and sends input to thecerebral cortex via thethalamus. It is critical for the functioning of thebasal ganglia.
Pallidotomy is an alternative todeep brain stimulation for the treatment of the involuntary movements known asdyskinesias which can become a problem in people withParkinson's disease after long-term treatment withlevodopa — a condition known aslevodopa-induced dyskinesia.[2] Whilst it used to be used a primary treatment for Parkinson's disease, it has been mainly replaced by levodopa.[3]
Pallidotomy may sometimes used to treat difficult cases ofessential tremor as an alternative to deep brain stimulation.[4] It may also be used fordystonia, andhemiballismus.[3]
Unilateral posteroventral pallidotomy can be effective at reducing Parkinsonism. However, it is associated with impaired language learning (if performed on thedominant hemisphere) or impaired visuospatial constructional ability (if performed on thenon-dominant hemisphere). It can also impairexecutive functions.[5]Bilateral pallidotomy will not reduce Parkisonistic symptoms.[6][7] It will cause severeapathy anddepression, along with slurred, unintelligible speech, drooling, andpseudobulbar palsy.[6][7]
The surgery itself can cause complications.[3] Damage to a blood vessel may causeintracranial haemorrhage.[3] Damage to theoptic tract can cause a permanent vision problem.[3] Pressure on brain tissue can induce aseizure.[3]
Pallidotomy involves placing a tiny electrical probe in the globus pallidus, one of thebasal ganglia of thebrain. Acraniotomy (temporary hole in the skull) needs to be created.[3] The probe is guided based onstereotactic information, and sometimesmagnetic resonance imaging.[3] The globus pallidus is heated for a short time to destroy a small area ofbrain cells.[3]
Pallidotomy has been used to treatParkinson's disease since at least the 1950s.[3] Older techniques involved occluding theanterior choroidal artery, with lower success rates and more side effects.[3]