Dp. Friedman et al., Stereotactic radiosurgical pallidotomy and thalamotomy with the gamma knife: MR imaging findings with clinical correlation - Preliminary experience, RADIOLOGY, 212(1), 1999, pp. 143-150
Citations number
22
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Medical Research Diagnosis & Treatment
PURPOSE: To evaluate the temporal evolution and appearance of a radiosurgic
al lesion at magnetic resonance (MR) imaging and the clinical response in p
atients undergoing stereotactic radiosurgical pallidotomy or thalamotomy wi
th the gamma knife.
MATERIALS AND METHODS: Seventeen patients with medically refractory movemen
t disorders underwent stereotactic radiosurgical pallidotomy (n = 2) or tha
lamotomy (n = 15). A single dose of 120-140 Gy was administered to a target
in the globus pallidus interna or ventralis intermedius thalamic nucleus.
Postprocedure gadolinium-enhanced MR imaging and clinical assessment were p
erformed at 1 month and 3 months.
RESULTS: At 3 months, the radiosurgical lesion most commonly (n = 11) appea
red as a ring-enhancing focus 5 mm or less in diameter surrounded by vasoge
nic edema that extended less than 7 mm in radius beyond the target. Five pa
tients had ring-enhancing lesions 7 mm or more in diameter; four of these d
eveloped symptomatic perilesional edema at 3 (n = 2) or 8 (n = 2) months af
ter the procedure. Onset of therapeutic effect began approximately 4 weeks
after treatment. In the 15 patients with tremor, there was a mean decline o
f 2.1 on the Tremor Rating Scale.
CONCLUSION: Findings in this pilot study suggest that radiosurgical thalamo
tomy is a promising treatment for medically refractory tremor. Three-month
follow-up Mr studies show a ring-enhancing lesion surrounded by a variable
amount of vasogenic edema. Visualization of the radiosurgical lesion and th
e clinical response are delayed compared to that with radio-frequency proce
dures.