Bilateral thalamotomy and pallidotomy as treatment for bilateral Parkinsonism.

Abstract

C LINICAL experience concerning the results of bilateral stereotaxic operations for parkinsonism to the present day is very limited. But meager information can be derived from the literature available. The question of bilateral thalamotomy is still ()pen to discussion. Hassler and Riechert ~ were the first to report postoperative states of impaired consciousness. According to their experience, these authors do not regard it justifiable to perform bilateral thalamic operations for bilateral parkinsonism, and they have advocated the combination of pallidotomy on one side and thalamotomy on the opposite. This opinion, which is stated again in their last paper, 6 is also shared by Walker. TM Spiegel 15 discussed the possibility of producing the effect of a leucotomy by cutting the thalamocortical pathway with a lesion located in the area of the nucleus ventralis anterior of the thalamus. Most of Cooper and Bravo's 3 patients with bilateral parkinsonism have had the pallidal operation on one side and the thalamotomy on the other. The feeling of Cooper ~ has been that he would hesitate to sacrifice the same structure bilaterally, no matter what that structure may be. I t is the purpose of this paper to review and compare the results of bilateral operations in our own series. In this series of ~63 cases of parkinsonism, bilateral operations have been performed on 51 patients. Of these 51 patients, ~3 have had bilateral thalamic operations, and in ~8 cases pallidotomy was performed on one side and thalamotomy on the opposite. The bilateral operation was