Türk Nöroşirürji Dergisi 2002 , Vol 12 , Num 3
Cevdet YAVUZ1, Haşmet A. HANAĞASI2, Hüseyin A. ŞAHİN2, Murat EMRE2, Orhan BARLAS1
1İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Nöroşirürji AD, İstanbul
2İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Nöroloji AD, İstanbul
Purpose: Thalamotomy is an effective treatment method for medically intractable Parkinson' s tremor. However, it is known that bilateral thalamotomy operation can cause some complications and mainly dysarthria This information is derived from bilateral "large" thalamotomy operations performed in the earlier years. The goal of our study was to investigate the outome of bilateral small thalamotomy in the treatment of Parkinson' s disease.

Matedal and methods: In this study, 9 patients (6 males, 3 females) diagnosed as having Idiopathic Parkinson's Disease (IPD) who despite appropriate medical therapy, had parkinsonian tremor, which significantly restricted their quality of life, were included. Bilateral ventralis intermedius (VIM) nuclei of thalamus were ablated stereotactically with small lesions contrary to the technique reported in literature to avoid possible complications.

Results: Postoperatively, five patients were free of bilateral tremor, in three patients the operation was very successful on one side and moderately successful on the other side. One patient improved on one side, however tremor did not improve on the other side. Mean Unified Parkinson's Disease Scale (UPDRS) tremor scores (subscares 20,21) decreased from 6,8±0,9 to 1,1±1 (p<0.000l) respectively. One or more complications such as dysarthria were encountered in five patients (two of them being more serious) reversible sonmolance was seen in two patients, dysphagia in one patient. Walking problems were present in one patient.

Conclusion: In our study we have found that small VIM thalamatamy is an effective treatment modality in medically intractable IPD. The complication rates are stil high although the lesions are smaller. This procedure should only be carefully performed in selected cases. Anahtar Kelimeler : Bilateral small thalamotomy, complication, idiopathic parkinson's disease