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What is a Pallidotomy?

  • In Parkinson’s disease, a part of the brain called the globus pallidus is overactive, which causes a decrease in the activity of a different part of the brain that controls movement.
  • In a pallidotomy, the surgeon destroys a tiny part of the globus pallidus by creating a scar.
  • This reduces the brain activity in that area, which may help relieve movement symptoms such as tremor and stiffness (rigidity).
  • Before surgery, detailed brain scans using MRI are done to identify the precise location for treatment.
  • Pallidotomy probably is not a good choice for treatment when a person has not responded to levodopa.
  • Surgery on one side of the brain affects the opposite side of the body. If you have tremor in your right hand, for instance, the left side of your brain will be treated

The procedure can be repeated on the other side of the brain if needed. Pallidotomy may be considered when a person with advanced Parkinson’s disease has:

  1. Developed severe motor fluctuations, such as dyskinesia and on-off responses, as a result of long-term levodopa treatment.
  2. Severe or disabling tremor, stiffness (rigidity), or slow movement (bradykinesia) that medication can no longer control.

How is the surgery performed?

  • The person is awake during the surgery, but the scalp area where instruments are inserted is numbed with a local anesthetic.
  • The surgeon inserts a hollow probe through a small hole drilled in the skull to the target location.
  • An extremely cold substance, liquid nitrogen, is circulated inside the probe.
  • The cold probe destroys the targeted brain tissue. The probe is then removed, and the wound is closed.

What can you expect after surgery?

The surgery usually requires a 2-day hospital stay. Most people recover completely within about 6 weeks. It is best to discuss the risks associated with your neurologist because there are many risk factors, including underlying medical conditions.

How often are they performed?

  • Doctors rarely perform pallidotomy anymore.
  • Instead, doctors use deep brain stimulation, a procedure that does not destroy brain tissue and has fewer risks than pallidotomy.

Page reviewed by Dr. Joash Lazarus, NPF Movement Disorders Fellow, Department of Neurology at Emory University School of Medicine.

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