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Complications of Gamma Knife Surgery for Parkinson Disease
Michael S. Okun, MD;
Natividad P. Stover, MD;
Thyagarajan Subramanian, MD;
Marla Gearing, PhD;
Bruce H. Wainer, MD, PhD;
Chad A. Holder, MD;
Ray L. Watts, MD;
Jorge L. Juncos, MD;
Alan Freeman, MD;
Marian L. Evatt, MD;
Stephan U. Schuele, MD;
Jerrold L. Vitek, MD, PhD;
Mahlon R. DeLong, MD
Arch Neurol. 2001;58:1995-2002.
Background Many medical centers throughout the world offer radiosurgery with the gamma knife (GK) for pallidotomy and thalamotomy as a safe and effective alternative to radiofrequency ablative surgery and deep brain stimulation for Parkinson disease (PD). The reported incidence of significant complications varies considerably, and the long-term complication rate remains unknown.
Design We describe 8 patients seen during an 8-month period referred for complications of GK surgery for PD.
Results Of the 8 patients, 1 died as a result of complications, including dysphagia and aspiration pneumonia. Other complications included hemiplegia, homonymous visual field deficit, hand weakness, dysarthria, hypophonia, aphasia, arm and face numbness, and pseudobulbar laughter. In all patients, lesions were significantly off target.
Conclusions The 8 patients with PD seen in referral at our center for complications of GK surgery highlight a spectrum of potential problems associated with this procedure. These include lesion accuracy and size and the delayed development of neurological complications secondary to radiation necrosis. Gamma knife surgery may have a higher complication rate than has been previously appreciated due to delayed onset and underreporting. We believe that the risk-benefit ratio of the GK will require further scrutiny when considering pallidotomy or thalamotomy in patients with PD. Physicians using this technique should carefully follow up patients postoperatively for delayed complications, and fully inform patients of these potential risks.
From the Departments of Neurology (Drs Okun, Stover, Wainer, Watts, Juncos, Freeman, Evatt, Vitek, and DeLong), Pathology (Drs Gearing and Wainer), and Radiology (Dr Holder), Emory University, Atlanta, Ga; and the Department of Neurology, The Cleveland Clinic, Cleveland, Ohio (Drs Subramanian and Schuele).
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