Clinical outcome of unilateral stereotactic pallidotomy without microelectrode recording for intractable Parkinson's disease

Objective: To study the effects of unilateral stereotactic pallidotomy perf ormed without microelectrode recording for advanced Parkinson's disease. Methods: Stereotactic coordinates were calculated by comparing preoperative inversion recovery MRI sequences with intraoperative CT scans. Conventiona l stereotactic stimulation techniques were employed to confirm correct prob e placement. Patients were assessed using a modified CAPIT protocol with th e off-state UPDRS motor score as the primary efficacy measure. Results: A statistically significant decline in off-state UPDRS motor score s occurred at 2 months (21% improvement in 32 patients) and also at 1 year postoperatively (30% improvement in 12 patients). Levodopa-induced dyskines ias on the side contralateral to surgery were reduced 97% in the cohort wit h I year of follow-up. No deleterious effects of surgery on global neuropsy chological functioning were seen, A major surgical complication (mild but p ersistent hemiparesis) occurred in one patient. Conclusions: We believe that stereotactic pallidotomy can be performed safe ly and effectively without microelectrode recording when coordinates are ca lculated using CT with comparison to preoperative MRI sequences. (C) 2000 E lsevier Science Ltd. All rights reserved.