Comparison analysis: Thalamotomy, GK thalamotomy, DBS for Parkinsonian tremor patients.

Mooseong Kim1


Keywords: gamma knife, Parkinson's Disease, tremor, deep brain stimulation, thalamotomy

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     Tremor, either essential tremor or Parkinsonian tremor, has been effectively and safely treated by GKS or RF lesioning or DBS the ventral intermediate(Vim) nucleus of the thalamus with or without microelectrode recording.
     The authors evaluate the treatment outcome of sixteen tremor patients who had been treated with thalamotomy without microelectrode, five parkinson''s disease with Gamma Knife, five parkinson''s disease with DBS.
     Between September, 2001, and December, 2011, sixteen tremor patients were treated with thalamotomy without microelectrode recording. Twelve patients suffered from Parkinsonian tremor and four patients were essential tremor patients. The male to female ratio was 1.6 to 1 with median age of 59.6 years (range; 39-74 years).
     Under local anesthesia, a 3mm hole was made using a hand-held twist drill, and the dura mater was penetrated with a 1.2mm sharp drill beat. Radiofrequency(RF) electrode was placed in the Vim nucleus of thalamus. With intraoperative macrostimulation, RF lesion was made. Five parkinson''s disease tremor patients were operated with bilateral Vim-DBS. Five parkinson''s disease tremor patients were operated with unilateral Vim-GK thalamotomy. A radiation dose of 120 Gy was delivered to nucleus using a single 4 mm collimator plug pattern following classic anatomical landmarks. Preoperative and postoperative tremor was evaluated with simple tremor severity scale, United Parkinson''s disease Rating Scale tremor score(UPDRS) and the development of complications related with the procedure was closely reviewed at the immediate postoperative period and the last follow-up.
     RF thalamotomy produces immediate relief in up to 98.4% of the patients. There were no development of complications related with procedure, all patients discharged one or two days after surgery. In DBS surgery patients ,Tremor was completely abolished in 40 % in patients, almost abolished in 60 %. There was no complications. GK thalamotomy patients produced an excellent improvement of tremor in four patients, mild improvement in one patient.
     This was a retrospective review.
     Vim thalamotomy without microelectrode recording is a safe and effective procedure to control the tremor with minimal morbidity. DBS is very beneficial in treating bilateral intractable tremor patients. Intraoperative macroelectrode stimulation safely localizes the Vim nucleus target of the thalamus for the treatment of patients with tremor.
     GK thalamotomy is for intractable unilateral tremor patients with medical disease, severe old age, coagulopathy,etc. Unilateral Vim GK thalamotomy is very effective for intractable tremor patients and contralateral side treated with Vim-DBS


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M. Kim ()