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What to Expect from a Pallidotomy

Overview

A pallidotomy is a procedure used to help people manage symptoms of Parkinson’s disease, such as tremors and stiffness. With this technique, surgeons destroy tissue in an area of the brain known as the globus pallidus.

Today, doctors rarely perform pallidotomies. Most prefer a procedure called deep brain stimulation (DBS) because it doesn’t destroy brain tissue and poses fewer risks. Read about the latest treatments for this progressive neurological disorder.

Read on to learn more about what happens during a pallidotomy and how to prepare for this surgery.

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Candidate

How to determine if you’re a good candidate

Your doctor might recommend a pallidotomy if you have advanced Parkinson’s disease along with:

  • severe tremors, stiffness, or movement difficulties that can no longer be controlled with medication
  • serious motor problems that have resulted from using the medication levodopa for a long time

If you’ve previously taken levodopa and haven’t responded positively to it, a pallidotomy probably isn’t a good treatment choice for you. Rather, this procedure is often recommended for someone who isn’t a candidate for DBS.

Sometimes, a pallidotomy is performed in people with dystonia. Dystonia is a movement disorder that causes a person’s muscles to contract uncontrollably.

Efficacy

How effective it is

A pallidotomy isn’t a cure for Parkinson’s. However, it may help reduce symptoms, such as tremor, muscle stiffness, and motor problems.

A pallidotomy is generally an effective procedure for people with Parkinson’s disease who are considered good candidates.

Studies have shown varying results, but one review found that the effectiveness of a unilateral pallidotomy is similar to that of unilateral DBS. A unilateral pallidotomy is a pallidotomy that’s only performed on one side of the brain. Still, bilateral DBS, which is DBS performed on both sides of the brain, was found to be the most successful treatment for managing symptoms of Parkinson’s disease.

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Preparation

How to prepare for surgery

Before your procedure, you’ll need detailed MRI scans. Images from MRI scans can help your doctor identify the exact location in your brain that needs to be targeted during surgery.

You’ll need to plan for a short hospital stay after your procedure.

Your doctor might give you a special shampoo to use the night before your operation. They may also tell you not to take certain medications in the days leading up to your surgery. Follow all your physician’s instructions carefully.

Procedure

What happens during the procedure

During a pallidotomy, you’ll be awake, but your scalp will be numbed with local anesthesia.

Your surgeon will drill a small hole in your skull and insert a probe through the hole. Then, they’ll distribute liquid nitrogen, an extremely cold substance, inside the probe. The cold probe destroys the brain tissue that your doctor targets. Other techniques include using high-frequency radio waves through the probe to achieve the same effect.

After this process is complete, your surgeon removes the probe from your skull and closes your wound.

Even though you’ll be awake during the pallidotomy, you should feel minimal pain. Your doctor will probably ask you questions during the procedure to make sure they’re treating the correct spot of your brain.

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Recovery

Recovery and what to expect

Typically, a pallidotomy requires a two-day hospital stay.

Most people fully recovery within six weeks, but each case is different. Your healthcare provider will probably tell you to avoid any strenuous activities, such as lifting or pushing heavy objects, for at least six weeks after your procedure.

It’s important that you don’t touch the stitches on your head. Your doctor will tell you when you can make an appointment to have them removed.

Call your physician right away if you experience any of the following symptoms during your recovery:

  • fever
  • chills
  • sweats
  • redness, swelling, or discharge around your incision
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Complications

Possible complications

There are risks associated with a pallidotomy, but improved technology has led to decreased incidence of complications. For example, doctors are now able to use imaging techniques to focus on precise areas of the brain and target those spots.

Risks of a pallidotomy may include:

Some studies have also shown that a pallidotomy, specifically a bilateral pallidotomy, can cause depression, speech problems, and worsening symptoms in certain people.

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Outlook

Outlook

Most surgeons prefer DBS over a pallidotomy, but both procedures can offer benefits to people with Parkinson’s disease. If you’ve experienced muscle or movement problems brought on by long-term use of levodopa, you can expect your symptoms to improve after this surgery. Ask your doctor about a pallidotomy if you think you might be a good candidate.

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