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Other Surgical Options

What is a Thalamotomy?

  • A type of brain surgery in which the thalamus, a tiny area of the brain, is lesioned.
  • Before surgery, detailed brain scans using a CT scan or MRI identify the precise location for treatment.
  • Surgery on one side of the brain affects the opposite side of the body. If you have tremor in your right hand, for instance, the left side of your brain will be treated.
  • The procedure can be repeated on the other side of the brain if needed, but it greatly increases the risk of speech and cognitive problems after surgery if both sides are done.

How is the surgery performed?

  • During the surgery, the patient is awake, but the scalp area where instruments are inserted is numbed with a local anesthetic.
  • The surgeon inserts a hollow probe through a small hole drilled in the skull to the target location.
  • An extremely cold substance, liquid nitrogen, is circulated inside the probe. The cold probe lesions the targeted brain tissue.
  • The probe is then removed and the wound is closed.

What to expect after surgery?

The surgery usually requires a two-day hospital stay. Most people recover completely within about six weeks.  Because there are many risk factors, including underlying medical conditions, discuss the risks with your neurologist.

How common is this surgery?

  • Thalamotomy is rarely done today.
  • May be used to treat severe tremor on one side of the body (most often in an arm or leg) that does not respond to medications.
  • Does not assist with slow movement (bradykinesia), speech problems or walking difficulties.

Pallidotomy

What is a pallidotomy?

  • In PD a part of the brain called the globus pallidus is overactive. This causes a decrease in the activity of a different part of the brain that controls movement. In a pallidotomy, the surgeon lesions a tiny part of the globus pallidus by creating a scar.
  • This reduces the brain activity in that area, which may help relieve movement symptoms such as tremor and stiffness (rigidity).
  • Before surgery, detailed brain scans using MRI identify the precise location for treatment.
  • Most likely not a good option for treatment when a person has not responded to levodopa.
  • Surgery on one side of the brain affects the opposite side of the body. If you have tremor in your right hand, for instance, the left side of your brain will be treated

The procedure can be repeated on the other side of the brain if needed. Pallidotomy may be considered when a person with advanced PD disease has:

  1. Severe motor fluctuations, such as dyskinesia and on-off responses, due to long-term levodopa treatment.
  2. Severe or disabling tremor, stiffness (rigidity) or slow movement (bradykinesia) medication can no longer control.

How is the surgery performed?

  • The person is awake during the surgery, but the scalp area where instruments are inserted is numbed with a local anesthetic.
  • The surgeon inserts a hollow probe through a small hole drilled in the skull to the target location.
  • An extremely cold substance, liquid nitrogen, is circulated inside the probe.
  • The cold probe lesions the targeted brain tissue. The probe is then removed, and the wound is closed.

What to expect after surgery?

The surgery usually requires a two-day hospital stay. Most people recover completely within about six weeks.  Because there are many risk factors, including underlying medical conditions, discuss the risks with your neurologist.

How common is this surgery?

  • Doctors rarely perform pallidotomy anymore.
  • Instead, doctors use deep brain stimulation, a procedure that does not destroy brain tissue and has fewer risks than pallidotomy.

What Is a subthalamotomy?

  • Subthalamotomy is a type of brain surgery in which the subthalamus, a tiny area of the brain, is destroyed.
  • Before surgery, detailed brain scans using a CT scan or MRI identify the precise location for treatment.
  • Surgery on one side of the brain affects the opposite side of the body. If you have tremor in your right hand, for instance, the left side of your brain will be treated.
  • The procedure can be repeated on the other side of the brain if needed, but it greatly increases the risk of speech and cognitive problems after surgery.

How is the surgery performed?

  • During the surgery, the patient is awake, but the scalp area where instruments are inserted is numbed with a local anesthetic.
  • The surgeon inserts a hollow probe through a small hole drilled in the skull to the target location.
  • An extremely cold substance, liquid nitrogen, is circulated inside the probe. The cold probe destroys the targeted brain tissue.
  • The probe is then removed, and the wound is closed.

What to expect after surgery?

The surgery usually requires a two-day hospital stay. Most people recover completely within about six weeks.  Because there are many risk factors, including underlying medical conditions, discuss the risks with your neurologist.

How often are they performed?

Subthalamotomy is rarely done today.

Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinson’s Foundation Center of Excellence.

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