Acta Neurochirurgica

, Volume 139, Issue 5, pp 442–445 | Cite as

Gamma knife pallidotomy: Case report

  • J. G. Bonnen
  • R. P. Iacono
  • B. Lulu
  • A. S. Mohamed
  • A. Gonzalez
  • T. Schoonenberg
Clinical Articles


We report a case of gamma knife pallidotomy resulting in a permanent contralateral homonymous hemianopsia and transient contralateral hemiparesis with some improvement in contralateral parkinsonian symptoms. This case illustrates the risk of gamma knife pallidotomy which precludes physiologic target localization and can subject structures surrounding the target to a significant radiosurgical dose. Until noninvasive physiologic target localization is available gamma knife pallidotomy and thalamotomy should be limited to patients with an unacceptably high risk for stereotactic percutaneous thermocoagulation.


Gamma knife radionecrosis spacial misregistrations posteroventral pallidotomy thalamotomy physiologic target localization 


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  1. 1.
    Aminoff MJ (1994) Treatment of Parkinson's disease. West J Med 161: 303–308PubMedGoogle Scholar
  2. 2.
    Burchiel KJ (1992) Image-based functional neurosurgery. Clin Neurosurg 39: 314–330PubMedGoogle Scholar
  3. 3.
    Cooper IS, Bravo G (1958) Chemipallidectomy and chemothalamectomy. J Neurosurg 15: 244PubMedGoogle Scholar
  4. 4.
    Fabbrini G, Mouradian MM, Juncos JL, Schlegel J, Mohr E, Chase TN (1988) Motor fluctuations in Parkinson's disease: central pathophysiological mechanisms, part I. Ann Neurol 24: 366–371PubMedGoogle Scholar
  5. 5.
    Flickinger J, Lunsford LD, Kondzioloka D (1992) Dose prescription and dose-volume effects in radiosurgery. In: Lunsford LD (ed) Stereotactic radiosurgery. Neurosurg Clin North Am 3 (1): 51–59Google Scholar
  6. 6.
    Grossman RG, Hamilton WJ (1993) Surgery for movement disorders. In: Jankovic T, Tolosa E (eds) Parkinson's disease and movement disorders. Williams and Wilkins, Baltimore, pp 531–548Google Scholar
  7. 7.
    Hariz M (1992) Correlation between clinical outcome and size and site of the lesion in computed tomography guided thalamotomy and pallidotomy. Stereotact Funct Neurosurg 54–55: 172–185Google Scholar
  8. 8.
    Hassler R, Riechert T (1954) Indikationen und Lokalisationsmethode der gezielten Hirnoperationen. Nervenarzt 25: 441PubMedGoogle Scholar
  9. 9.
    Iacono RP, Shima F, Lonser RR,et al (1995) The results, indications, and physiology of posteroventral pallidotomy for patients with Parkinson's disease. Neurosurgery 36: 1118–1127PubMedGoogle Scholar
  10. 10.
    Jones MW, Tasker RR (1990) The relationship of documented destruction of specific cell types to complications and effectiveness in thalamotomy for tremor in Parkinson's disease. Stereotact Funct Neurosurg 54–55: 207Google Scholar
  11. 11.
    Kawashima Y, Chen HJ, Takahashi A,et al (1992) Application of magnetic resonance imaging in functional stereotactic thalamotomy for the evaluation of individual variations of the thalamus. Stereotact Funct Neurosurg 58: 33–38PubMedGoogle Scholar
  12. 12.
    Kelly PJ (1995) Pallidotomy in Parkinson's disease. Neurosurgery 36: 1154–1157PubMedGoogle Scholar
  13. 13.
    Laitinen L (1972) Surgical treatment, past and present. In: Parkinson's disease. Acta Neurol Scand 51: 43Google Scholar
  14. 14.
    Laitinen LV, Bergenheim AT, Hariz MI (1992) Leksell's posterior ventral pallidotomy in the treatment of Parkinson's disease. J Neurosurg 76: 53PubMedGoogle Scholar
  15. 15.
    Laitinen LV, Bergenheim AT, Hariz MI (1992) Ventroposterolateral pallidotomy can abolish all parkinsonian symptoms. Stereotact Funct Neurosurg 58: 14PubMedGoogle Scholar
  16. 16.
    Laitinen LV (1995) Pallidotomy for Parkinson's disease. In: Lundsford LD (ed) Functional neurosurgery. Neurosurg Clin North Am 6(1): 105–110Google Scholar
  17. 17.
    Lindquist C, Steiner L, Hindmarsh T (1992) Gamma knife thalamotomy for tremor: report of two cases. In: Steiner L,et al (ed) Radiosurgery: baseline and trends. Raven, New York, pp 237–243Google Scholar
  18. 18.
    Michels J, Bosman H, Pelgrims P,et al (1994) On the problem of geometric distortion in magnetic resonance images for stereotactic neurosurgery. Magn Reson Imaging 12: 749–765PubMedGoogle Scholar
  19. 19.
    Narabayashi H (1989) Striatal symptoms. Stereotact Funct Neurosurg 52: 200PubMedGoogle Scholar
  20. 20.
    Narabayashi H (1990) Surgical treatment in the levodopa era. In: Stern G (ed) Parkinson's disease. Chapman and Hall, London, pp 597–646Google Scholar
  21. 21.
    Ohye Ch (1988) Selective thalamotomy for movement disorders: microelectrode stimulation techniques and results. In: Lundsford LD (ed) Modern stereotactic neurosurgery. Martinus Nijhoff, Boston, pp 315–331Google Scholar
  22. 22.
    Peters T, Pike GB, Clark J (1992) A personal computer based workstation for the planning of stereotactic neurosurgical procedures. In: Kelly P, Kall B (ed) Computers in stereotactic neurosurgery. Blackwell, BostonGoogle Scholar
  23. 23.
    Struppler A (1989) Stereoencephalotomy and control of skeletal muscle tone. Stereotact Funct Neurosurg 52: 205PubMedGoogle Scholar
  24. 24.
    Sumanaweera TS, Adler JR, Napel S, Glover GH (1994) Characterization of spatial distortion in magnetic resonance imaging and its implications for stereotactic surgery. Neurosurgery 35: 696–704PubMedGoogle Scholar
  25. 25.
    Svennilson E, Torvik A, Lowe R,et al (1960) Treatment of parkinsonism by stereotactic thermolesions in the pallidal region. Acta Psychiatr Neurol Scand 35: 358Google Scholar
  26. 26.
    Tasker RR, Siqueira J, Hawrylyshyn P,et al (1983) What happened to Vim thalamotomy for Parkinson's disease? Appl Neurophysiol 46: 68PubMedGoogle Scholar
  27. 27.
    Wester K, Hauglie-Hanssen E (1990) Stereotaxic thalamotomy-experiences from the levodopa era. J Neurol Neurosurg Psychiatry 53: 427–430PubMedGoogle Scholar
  28. 28.
    Wu A (1992) Physics and dosimetry of the gamma knife. In: Lunsford LD (ed) Stereotactic radiosurgery. Neurosurg Clin N Am 3 (1): 35–50Google Scholar
  29. 29.
    Yahr MD (1993) Parkinson's disease: new approaches to diagnosis and treatment. Acta Neurol Scand 87 [Suppl] 146: 22–25Google Scholar

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • J. G. Bonnen
    • 1
  • R. P. Iacono
    • 2
  • B. Lulu
    • 3
  • A. S. Mohamed
    • 2
  • A. Gonzalez
    • 2
  • T. Schoonenberg
    • 2
  1. 1.Division of NeurosurgeryThe University of Texas Medical BranchGalveston
  2. 2.Clinical Neuroscience Research GroupLoma Linda University Medical CenterLoma Linda
  3. 3.Radiation OncologyArizona UniversityTucsonUSA

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