Background

Stereotactic posteroventral pallidotomy treats movement disorders through neurosurgery.

The procedure involves precise stereotactic destruction of the globus pallidus’ posteroventral region

The globus pallidus is a basal ganglia structure that regulates movement in the brain.

Parkinson’s disease involves abnormal basal ganglia activity causes tremor, rigidity, bradykinesia, and instability.

Posteroventral globus pallidus region involved in symptoms. SPVP aims to relieve motor symptoms by disrupting abnormal basal ganglia signals.

Pallidotomy reduces symptoms in patients unresponsive to medication or experiencing problematic side effects from treatments.

Patients with uncontrolled motor symptoms or medication side effects may struggle.

Indications

Parkinson’s Disease

Dystonia

Essential Tremor

Levodopa-induced dyskinesias

Medication-resistant rigidity and bradykinesia

Severe motor fluctuations

Contraindications

Severe cognitive impairment

Severe psychiatric disorders

Extensive cerebrovascular disease or brain atrophy

Infection or active systemic illness

Bilateral pallidotomy

Young patients with early-stage Parkinson’s disease

Severe speech or swallowing difficulties

Outcomes

Moderate improvement in movement slowness and stiffness. Tremor control improves 50–80% effectively.

Improvements are sustained for years but disease progression may eventually lead to symptom recurrence.

Unilateral pallidotomy yields better outcomes than bilateral procedures which have higher complication risks and maintain levodopa needs.

Unilateral procedures reduce cognitive risks but can affect speech considering alternatives for cognitive impairments or gait issues.

Equipment required

Magnetic Resonance Imaging Scanner

Computed Tomography Scanner

Stereotactic Planning Software

Stereotactic Frame

Targeting Arc System

Microdrive System

Microelectrode Recording System

Test Stimulation Generator

Radiofrequency Electrode

Burr Hole Drill

Cannula and Guide Tubes

Sterile Surgical Instruments

Patient Preparation:

Patient assessment include neurological assessment, cognitive and psychiatric evaluation, and imaging studies.

Procedure is performed under local anesthesia with sedation. MRI or CT imaging locates posteroventral globus pallidus.

Microelectrode recording confirms target placement via abnormal activity detection.

Radiofrequency electrode ablates tissue using temperature-controlled heat application.

Informed Consent:

Explain the procedure’s risks and potential complications clearly to the patient.

Patient Positioning:

Patient’s head secured for precise targeting setup.

Figure. Pallidotomy of brain to treat parkinson’s disease.

Stereotactic Targeting and Microelectrode Recording

A Burr hole created in skull using stereotactic guidance. Then Microelectrode inserted for recording purpose.

Finally test stimulation may be performed to assess symptom response and side effects.

Lesioning Procedure:

Radiofrequency electrode inserted stereotactically. A test lesion is applied first.

Final lesioning is done using radiofrequency thermal coagulation.

Multiple passes used to create an effective lesion.

Complications:

Hemiparesis

Gait and Balance Impairment

Visual or Oculomotor Disturbances

Dysarthria

Intracerebral Hemorrhage

Infection

Seizures

References

Stereotactic pallidotomy for treatment of Parkinson’s disease – Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews – NCBI Bookshelf

References

Stereotactic pallidotomy for treatment of Parkinson’s disease – Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews – NCBI Bookshelf