Medical Health Encyclopedia

Pallidotomy is a surgical procedure that may restore normal brain activity related to voluntary movement in some patients. It is not a cure, however, and its primary benefit is to allow people to continue on medications without incurring some of the side effects. The procedure is irreversible and generally works as follows:

• The patient's head is immobilized using a stereotactic frame and imaging techniques are used to visualize the injured areas.
• The neurosurgeon drills a small hole into the skull and inserts an electrode.
• The electrode generates a current and heat to destroy small amounts of tissue in the globus pallidus, a part of the brain responsible for many Parkinson's symptoms, particularly those that develop after long-term use of levodopa.
• The patient is awake during the operation, which takes about six hours.
• The hospital stay averages two days.

To date, the standard procedure involves one side of the brain (unilateral pallidotomy). Bilateral pallidotomy (surgery on both sides of the brain) is being researched but to date has higher complication rates than unilateral procedures. Patients should have the surgery performed only in centers that have experience with the procedure.

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Candidates. In general, appropriate candidates for unilateral pallidotomy are patients with advanced disease who no longer benefit from drug treatments. Unfortunately, only about 5% to 10% of Parkinson's patients are candidates. The procedure is generally not recommended for the following:

• Patients who do not respond to levodopa.
• The very elderly.
• Patients whose primary symptom is tremor.
• Patients whose predominant symptoms are freezing and falling (especially during on-periods).
• Patients who have serious medical or mental disorders.
• Patients with parkinsonism (as opposed to idiopathic Parkinson's disease).