unilateral_pallidotomy [Neurosurgery Wiki]

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Pallidotomy has gone through several ebbs and flows. [[Unilateral pallidotomy]] is currently recommended for dystonia and  [[Parkinson's disease treatment]] of motor symptoms. The need for further research and improved technology to make the technique safer and prove its efficacy is highlighted, especially keeping in mind a large number of populations to which the prohibitively expensive deep brain stimulation is unavailable
((Agrawal M, Garg K, Samala R, Rajan R, Singh M. A Scientometric Analysis of the 100 Most Cited Articles on Pallidotomy. Stereotact Funct Neurosurg. 2021 Jun 2:1-11. doi: 10.1159/000516237. Epub ahead of print. PMID: 34077938.)).

Pallidotomy is an alternative to [[deep brain stimulation]] for the treatment of the involuntary movements known as [[dyskinesia]]s which can become a problem in people with [[Parkinson's disease]] after long-term treatment with [[levodopa]] — a condition known as levodopa-induced dyskinesia.

It is also sometimes used an alternative to deep brain stimulation to treat difficult cases of [[essential tremor]].

Unilateral posteroventral pallidotomy can be effective at reducing [[Parkinsonism]], but is associated with impaired language learning (if performed on the dominant hemisphere) or impaired visuospatial contructional ability (if performed on the non-dominant hemisphere). It can also impair executive functions.

[[Bilateral pallidotomy]] will not reduce Parkisonistic symptoms but will cause severe apathy and depression along with slurred unintelligible speech, drooling, and pseudobulbar palsy.
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Pallidotomy has long been an accepted procedure and the indications for this surgery, in the opinion of the responding centers of a survey of current practice in North America (1996), were rated on a scale of 1 (poor) to 4 (excellent) and demonstrated dyskinesia as the best indication (median = 4); on-off fluctuations, dystonia, rigidity, and bradykinesia as good indications (median = 3); and freezing, tremor and gait disturbance as fair indications (median = 2). Most centers used MRI alone (50%) or in combination with CT scan (n = 6) or ventriculopathy (n = 5) to localize the target. The median values of pallidal coordinates were: 2 mm anterior to the midcommissural point 21 mm lateral to the midsagittal plane and 5 mm below the intercommissural line. Microrecording was performed by half of the centers (n = 14) and half of the remaining centers were considering starting it (n = 7). Main criteria used to define the target included the firing pattern of spontaneous neuronal discharges (n = 13) and the response to joint movement (n = 10). Most centers performed motor (n = 26) and visual (n = 23) macrostimulation. Twenty four centers performed test lesions using median values of 55 degrees C temperatures for 30 s. Final lesions consisted of 3 permanent lesions placed 2 mm apart, each lesion created with median values of 75 degrees C temperatures for 1 minute. Median hospital stay was 2 days
((Favre J, Taha JM, Nguyen TT, Gildenberg PL, Burchiel KJ. Pallidotomy: a survey
of current practice in North America. Neurosurgery. 1996 Oct;39(4):883-90;
discussion 890-2. PubMed PMID: 8880789.)).