Radiosurgical Pallidotomy for Parkinson’s Disease by Leslie D. Cahan, Ronald F. Young and Francisco Li. Pages 149-157 in: Current Concepts in Movement Disorder Management, Published by Karger, Basel, Switzerland and edited by Ajay Niranjan, L. Dade Lunsford and R. Mark Richardson, published in 2018.
Most patients with Parkinson’s Disease (PD) who fail medical management are offered Deep Brain Stimulation (DBS) as a surgical method to improve symptoms of tremor, rigidity (stiffness) and bradykinesia (slowness of movement.) In this chapter, in the most recent textbook on the management of movement disorders, California Gamma Knife neurosurgeons Dr. Les Cahan and Dr. Ron Young discuss their experience with using the Gamma knife to produce a lesion in the Globus Pallidus, a procedure called Pallidotomy, to treat advanced PD. Unlike DBS, Gamma Knife Pallidotomy is a non-invasive, out patient procedure which is nearly as effective as DBS in reducing the symptoms of advanced PD. A significant advantage of Gamma Knife Pallidotomy over DBS is that it can be offered to patients who might need surgical intervention but cannot have DBS because they take blood thinning medications or they have cognitive deficits or other contraindications to DBS such as advanced age. The chapter describes improvements of a mean of 34 points in the UPDRS (Unified Parkinson’s Disease Rating Scale) scores one year after Gamma Knife Pallidotomy and a 13 point improvement sustained over an average of 91 months after the procedures. Bilateral or both sided Gamma Knife Pallidotomy performed in a staged manner, with one year between the first and second procedures, produced a 25 point improvement in UPDRS scores an average of 74 months after the procedures. Only two of 51 procedures resulted in complications (4%) which is substantially less than the overall complication rate of DBS. Gamma Knife Pallidotomy should be considered for all patients with advanced Parkinson’s Disease particularly those who are unsuited to DBS or who do not wish to deal with implanted hardware. California Gamma Knife is the world leader in the performance of Gamma Knife Pallidotomy to treat advanced PD.
Stereotactic Radiosurgery for tremor: systematic review International Stereotactic Radiosurgery Society practice guidelinesRead Now
A report has appeared in the Februrary 2018 issue of the prestigious Journal of Neurosurgery which contains a recommendation of the International Stereotactic Radiosurgery Society (ISRS) for the use of the Gamma Knife to treat tremor (Martinez-Marino, N.D. et al, Stereotactic Radiosurgery for tremor: systematic review International Stereotactic Radiosurgery Society practice guidelines, J. Neurosurg. Publish Before Print, February 23, 2018). The conclusion of the report states “Stereotactic Radiosurgery (i.e. Gamma Knife)…….is a well tolerated and effective treatment for reducing medically refractory tremor and one that is recommended by the International Stereotactic Radiosurgery Society.
The ISRS is the major international society composed of medical professionals from around the world who employ stereotactic radiosurgery. The recommendation is of great significance since for many years the American Academy of Neurology has insisted that Gamma Knife treatment of tremor was “experimental” or “investigational” and therefore dissuaded some neurologists from recommending it for treatment of their patients with tremor. This well researched recommendation by the ISRS should put such ill placed concerns to rest. They have reaffirmed what we have been saying for years, that the Gamma Knife is a safe and effective treatment for tremor. This is good news for all patients who suffer from tremor.