Thalamotomy without Microelectrode Recording.

Jeon, Sang Ho; Kim, Moo Seong; Lee, Sun Il; Jung, Yong Tae; Sim, Jae Hong; Burchiel, Kim J

Original Article

Journal of Korean Neurosurgical Society 2005;37(2): 105-111.

Sang Ho Jeon, Moo Seong Kim, Sun Il Lee, Yong Tae Jung, Jae Hong Sim, Kim J Burchiel

¹Department of Neurosurgery, Inje University Busan Paik Hospital, Busan, Korea. 667196@hanmail.net
²Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon, USA.

ABSTRACT

OBJECTIVE
Tremor, either essential tremor or Parkinsonian tremor, has been effectively and safely treated by lesioning the ventral intermediate(Vim) nucleus of the thalamus with or without mircroelectrode recording. The authors evaluate the treatment outcome of sixteen tremor patients who had been treated with thalamotomy without microelectrode.
METHODS
Between September, 2001, and December, 2003, sixteen tremor patients were treated with thalamotomy without microelectrode recording. Twelve patients suffered from Parkinsonian tremor and four patients were essential tremor patients. The male to female ratio was 1.6 to 1 with median age of 59.6 years (range; 39-74 years). Under local anesthesia, a 3mm hole was made using a hand-held twist drill, and the dura mater was penetrated with a 1.2mm sharp drill beat. Radiofrequency(RF) electrode was placed in the Vim nucleus of thalamus. With intraoperative macrostimulation, RF lesion was made. Postoperative CT scan and/or MR imaging was performed to confirm the localization of the target lesioned. Preoperative and postoperative tremor was evaluated with simple tremor severity scale and the development of complications related with the procedure was closely reviewed at the immediate postoperative period and the last follow-up. RESULTS: It produces immediate relief in up to 98.4% of the patients. There were no development of complications related with procedure, all patients discharged one or two days after surgery.
CONCLUSION
Vim thalamotomy without microelectrode recording is a safe and effective procedure to control the tremor with minimal morbidity. Intraoperative macroelectrode stimulation safely localizes the Vim nucleus target of the thalamus for the treatment of patients with tremor.

Key Words: Tremor; Thalamotomy; Macroelectrode