Posteroventral medial pallidotomy in levodopa-unresponsive parkinsonism
J. K. Krauss, J. Jankovic, E. C. Lai, G. M. Rettig and R. G. Grossman
Department of Neurosurgery, Baylor College of Medicine, Houston, Tex., USA.
BACKGROUND: Parkinsonism in a 42-year-old patient, which was presumably
related to peripheral trauma, did not respond to levodopa therapy.
OBSERVATION: We treated the patient with microelectrode-guided unilateral
posteroventral medial pallidotomy and followed up with magnetic resonance
imaging and prospective clinical evaluation. Pallidotomy resulted in marked
improvement of right-sided parkinsonian symptoms and functional disability
at 4.5 months after surgery. Microelectrode recording during pallidotomy
revealed discharge patterns that were similar to those seen in patients
with Parkinson disease. Postoperative magnetic resonance imaging confirmed
the location of the lesion in the posteroventral medial pallidum.
CONCLUSIONS: Posteroventral pallidotomy usually has limited benefit in
patients with degenerative atypical parkinsonism who do not respond to
levodopa therapy. Nevertheless, pallidotomy can be an effective treatment
for other levodopa-unresponsive parkinsonian disorders.
