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Research paper
Subthalamotomy for Parkinson’s disease: clinical outcome and topography of lesions
  1. Rafael Rodriguez-Rojas1,2,
  2. Maylen Carballo-Barreda3,
  3. Lazaro Alvarez3,
  4. Jorge Guridi4,
  5. Nancy Pavon3,
  6. Ivan Garcia-Maeso3,
  7. Raul Mací­as3,
  8. Maria C Rodriguez-Oroz2,5,
  9. Jose Angel Obeso1,2
  1. 1 HM CINAC, Hospital Universitario HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain
  2. 2 CIBERNED, Institute Carlos III, Madrid, Spain
  3. 3 Brain Images Processing Group and Movement Disorder Unit, International Center for Neurological Restoration, Havana, Cuba
  4. 4 Service of Neurosurgery, Clinica Universidad de Navarra, Pamplona, Spain
  5. 5 BioDonostia Health Research Institute, Basque Center on Cognition Brain and Language, San Sebastian, Guipuzcoa, Spain
  1. Correspondence to Professor Jose Angel Obeso, HM CINAC, Hospital Universitario HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid 28938, Spain; jobeso.hmcinac{at}hmhospitales.com

Abstract

Objective Subthalamotomy is an effective alternative for the treatment of Parkinson’s disease (PD). However, uncertainty about the optimal target location and the possibility of inducing haemichorea-ballism have limited its application. We assessed the correlation between the topography of radiofrequency-based lesions of the subthalamic nucleus (STN) with motor improvement and the emergence of haemichorea-ballism.

Methods Sixty-four patients with PD treated with subthalamotomy were evaluated preoperatively and postoperatively using the Unified Parkinson’s Disease Rating Scale motor score (UPDRSm), MRI and tractography. Patients were classified according to the degree of clinical motor improvement and dyskinesia scale. Lesions were segmented on MRI and averaged in a standard space. We examined the relationship between the extent of lesion-induced disruption of fibres surrounding the STN and the development of haemichorea-ballism.

Results Maximum antiparkinsonian effect was obtained with lesions located within the dorsolateral motor region of the STN as compared with those centre-placed in the dorsal border of the STN and the zona incerta (71.3%, 53.5% and 20.8% UPDRSm reduction, respectively). However, lesions that extended dorsally beyond the STN showed lower probability of causing haemichorea-ballism than those placed entirely within the nucleus. Tractography findings indicate that interruption of pallidothalamic fibres probably determines a low probability of haemichorea-ballism postoperatively.

Conclusions The topography of the lesion is a major factor in the antiparkinsonian effect of subthalamotomy in patients with PD. Lesions involving the motor STN and pallidothalamic fibres induced significant motor improvement and were associated with a low incidence of haemichorea-ballism.

  • subthalamic nucleus
  • parkinson’s disease
  • subthalamotomy
  • magnetic resonance imaging

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Footnotes

  • Contributors RR-R, MC-B and JAO assisted with the study concept and design. LA, NP, IG-M and RM contributed to the recruitment of patients. LA, IG-M and RM performed surgical procedures. RR-R and MC-B were responsible for imaging acquisition, processing and analysis. LA, JG, NP, MCR-O and JAO assessed clinical visits and participated in the clinical data collection. RR-R, MC-B and JAO designed figures and drafted the first version of the manuscript. All authors contributed to the revisions of the manuscript and made contributions to the final manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Scientific committee, International Center for Neurological Restoration and the Cuban National Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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