Pallidotomy is a risky surgical procedure that involves damaging part of the globus pallidus in the brain to treat Parkinson’s disease. The patient is awake during the procedure, and detailed brain scans are done before surgery. Recovery takes several days in the hospital and several weeks at home. Deep brain stimulation is a safer alternative to pallidotomy.
A pallidotomy is a surgical procedure in which part of the globus pallidus, an area of the brain located within the basal ganglia, is damaged so it can’t function. As the “-otomy” suffix suggests, a pallidotomy is performed by cutting into the brain with a specialized probe to access the area of interest. This procedure can be very risky and is only done when it is the best option available to the patient.
One could reasonably ask under what circumstances the destruction of a part of the brain would be considered an acceptable treatment for a patient. Pallidotomies are performed on patients with Parkinson’s disease. This disease is characterized by shaking and uncontrolled movements. In the initial stages, the shaking can be controlled with drugs that suppress the action of the cells of the globus pallidus, reducing the shaking. When these medicines stop working, some cells may need to be damaged to stop them from activating.
During the pallidotomy, the patient is awake. The patient is kept awake because it is important for the surgical team to receive feedback from the patient when the probe is placed. Detailed brain scans are done before surgery so the surgeon knows where to go, and the patient’s head is placed in a frame that keeps it completely still. When the probe is inserted, the team receives feedback from the patient to confirm that the probe is in the right place, and once placed, the pallidotomy can be performed.
If movement problems are limited to one side of the body, a unilateral pallidotomy will be done to address the affected side only. If the whole body is involved, a bilateral pallidotomy will be performed. Both require the placement of milling holes in the skull to access this area of the brain. Recovery in the hospital after the procedure takes several days, and the patient needs several weeks to recover at home.
A potentially serious complication of this procedure is a stroke caused by bleeding in the brain, which can lead to further complications in the future. The surgeon also runs the risk of damaging other areas of the brain. Because of these risks, deep brain stimulation is a popular alternative to pallidotomy, as it is much less dangerous. After the surgery, a neurologist will follow up with the patient to confirm that the procedure was successful and to identify any signs of worrying complications.
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