Stereotactic ??-Thalamotomy with a Computerized Brain Atlas

Stereotactic Radiosurgical Pallidotomy and Thalamotomy with the Gamma Knife: MR Imaging Findings with Clinical Correlation—Preliminary Experience

“…The gamma knife has an established role in the treatment of cerebral arteriovenous malformations, cerebral metastases, and certain primary intracranial neoplasms, but its role in the treatment of other diseases, including movement disorders, is currently under evaluation. To our knowledge, there are very few studies in the literature that evaluate the efficacy of stereotactic radiosurgery for movement disorders; most of the studies contain a very small number of patients, and the reported clinical response was variable (6)(7)(8)(9)(10). Findings in our pilot study show that radiosurgical thalamotomy with the gamma knife is a promising treatment for patients with medically refractory tremor.…”

“…Stereotactic radiosurgical ablation of the globus pallidus interna (pallidotomy) or ventralis intermedius nucleus of the thalamus (thalamotomy) with the gamma knife stereotactic radiosurgery unit represents a new treatment for patients with severe movement disorders, particularly those who are poor candidates for stereotactic neurosurgical procedures (6)(7)(8)(9)(10). Radiosurgery with the gamma knife is a minimally invasive, closed-head procedure that offers the possibility of safer ablation of the target than is possible with conventional open neurosurgical procedures; in particular, the risk of acute hemorrhage should be totally eliminated.…”

“…Radiosurgery with the gamma knife is a minimally invasive, closed-head procedure that offers the possibility of safer ablation of the target than is possible with conventional open neurosurgical procedures; in particular, the risk of acute hemorrhage should be totally eliminated. Prior descriptions of these procedures have been mostly limited to very small series or case reports, without systematic follow-up magnetic resonance (MR) imaging (6)(7)(8)(9)(10). In this pilot study, we evaluated the temporal evolution and appearance of the radiosurgical lesion at MR imaging and the clinical response in a group of patients undergoing stereotactic radiosurgical pallidotomy or thalamotomy.…”

Gamma knife radiosurgery as a lesioning technique in movement disorder surgery

“…73,74,78 For thalamotomy lesions, the intent was to place the lesions in the nucleus ventralis intermedius and the posterior portion of the ventralis oralis posterior ventrolateral nucleus, contralateral to the side of the patient's more severe tremor. 16,20,24,[52][53][54] The anteroposterior or y coordinate was calculated from the atlas and adjusted as just described. The x or lateral coordinate was determined from coronal images such that the lateral border of the lesion was calculated to coincide with the lateral thalamic border, that is, the junction between the thalamus and internal capsule ( Fig.…”

“…10,21,28,30,51,58,60,71,72,75,76 Some limited reports on the use of the gamma knife to treat movement disorders have also appeared. 13,17,19,34,47,48,[52][53][54]57,73,78 In this report, we describe our experience in treating movement disorders using the gamma knife. Both thalamotomy and pallidotomy have been used to treat a variety of movement disorders, including those related to Parkinson's disease (PD), as well as essential tremor, tremor following stroke, and tremor following cerebral infarction.…”