Early postoperative complications and one-year follow-up after posteroventral pallidotomy and ventral intermediate nucleus thalamotomy for Parkinson’s disease. A single center study, cairo, Egypt

Abstract

BACKGROUND: Ablative procedures for Parkinson's disease (PD) remain effective because they target the dysfunctional neural circuits causeing symptoms such as tremor, rigidity, and slowed movement. While deep brain stimulation (DBS) has emerged as the gold standard for surgical care of PD due to its reversibility, ablative procedures remain necessary in particular circumstances. As in higher risk of infection, limited healthcare resources andfinancial constraints. Ablative surgeries are a good, reasonably priced option for relieving symptoms. OBJECTIVES: This study looked at the early postoperative complications of stereotactic radiofrequency thalamotomy and pallidotomy in people with PD. METHODS: This study showed a single-center one-year follow-up for (30 cases). Data were analyzed regarding the technical safety and efficacy of ablative procedures, especially in a healthcare setting with limited resources. Thirty patients diagnosed with PD were enrolled for stereotactic radiofrequency ablation (RF). The surgical procedures included (1) posteroventral pallidotomy when targeting the posteroventral portion of the globus pallidus internus (GPi), (2) ventral intermediate nucleus thalamotomy when targeting the ventral intermediate nucleus of the thalamus (VIM), and (3) unilateral both lesions for patients with both rigidity and tremors as there was risk to ablate the STN (sub thalamic nucleus). RESULTS: There were improvements in tremor, bradykinesia, rigidity, and gait. However, improvement was more pronounced and statistically significant only in tremors and rigidity grades. The postoperative complications experienced were weakness in 1 patient (3.3%), speech problems in 3 patients (10%), transient confusion in 3 patients (10%), and thalamic ataxia in 1 patient (3.3%), while there were no cases with disturbed conscious level (DCL) or massive intracerebral hemorrhage in the studied patients. CONCLUSION: Ablative procedures for PD management pose minimal risk to patients, making them an acceptable alternative to DBS in selected patients.