Jy. Lim et al., DELAYED INTERNAL CAPSULE INFARCTIONS FOLLOWING RADIOFREQUENCY PALLIDOTOMY - REPORT OF 3 CASES, Journal of neurosurgery, 87(6), 1997, pp. 955-960
The authors report on a series of patients with idiopathic Parkinson's
disease (IPD) who underwent stereotactic radiofrequency (RF) pallidot
omies, three of whom suffered delayed postoperative strokes. These thr
ee belonged to a group consisting of 42 patients with medically intrac
table IPD in whom 50 pallidotomies were performed. All three patients
had significant previous vascular disease and were in a high risk grou
p for cerebral infarction. A postoperative magnetic resonance (MR) ima
ge was obtained immediately after the pallidotomy was performed to doc
ument the placement of the RF lesion and to rule out any hematoma. The
delayed strokes occurred on postoperative Days 10, 51, and 117 in pat
ients with previous vascular disease (Group 1, 11 patients). No stroke
s occurred in the group with the vascular disease risk factor (Group 2
, 11 patients) or in the group with no risk factors for vascular disea
se (Group 3, 20 patients). This observation is statistically significa
nt (p < 0.05). The T-2-weighted MR images showed the lesions as high-i
ntensity signals extending to the posterior limb of the internal capsu
le ipsilateral to the pallidotomy site. The poststroke T-1-weighted im
ages obtained in two patients showed persistent contrast enhancement o
f the RF lesion and no enhancement around the stroke lesion. Clinicall
y and radiographically, these discrete new lesions represent delayed i
nfarctions, suggesting that RF lesioning can induce delayed injury in
adjacent tissue. Patients with previously identified vasculopathy may
be at risk for delayed capsular infarction following RF pallidotomy.