Stereotactic ablation for patients with Parkinson’s disease (PD): technical insights and long-term outcomes

Abstract

Abstract Background Parkinson’s disease (PD) is one of the most common neurodegenerative diseases. It has motor and non-motor symptoms. The main goal for management is to improve the motor symptoms especially for symptoms that no longer respond adequately to medications. Medical treatment remains the mainstay in its management. With disease progression, motor fluctuations or drug-induced dyskinesia appear. This necessitates surgical intervention. Following the introduction of deep-brain stimulation (DBS), it has become the preferred surgical treatment.The challenges associated with DBS have brought ablative. Procedures back into consideration. Here we present a series of 24 cases of PD managed by stereotactic ablation of deep brain nuclei. Methods We included patients with a history of primary PD for more than 3 years with initial good response to Levodopa which show now marked ON/OFF fluctuations, dyskinesia, or decreased response to medications. We did a pre-op MRI for planning and routine lab investigations. Unified Parkinson’s Disease Rating Scale (UPDRS) motor part was done pre and postoperative. Postoperative CT was done to detect the size of lesion and undesirable complications. We used Leksell G-stereotactic frame (Elekta, Stockholm, Sweden) and radiofrequency generator with a bipolar probe with an active tip of 2 mm X 2 mm. Results Our study included 24 patients, 19 males, and 5 females. We did a total of 27 lesions in the globus pallidus internus (GPI), 13 lesions in the subthalamic nucleus (STN), and 45 lesions in the ventral intermediate nucleus (VIM) of the thalamus. We had a reduction in the mean daily Levodopa intake by 40%, the ON duration was doubled, and the UPDRS in the ON period was decreased by 32% and in the OFF by 34%. The difference between mean UPDRS in the ON and the OFF dropped from 10 to 4, denoting minor or fewer motor fluctuations. Conclusions Stereotactic ablation remains a good choice for surgical management of PD, especially in patients where deep brain stimulation (DBS) is contraindicated or unaffordable. With careful patient selection, proper planning, and adequate precautions, an optimal outcome can be achieved with minor adverse effects.