Five-year follow-up of unilateral posteroventral pallidotomy in Parkinson's disease

Surg Neurol. 2009 May;71(5):551-8. doi: 10.1016/j.surneu.2008.03.039. Epub 2008 Jun 2.


Background: Neurocognitive outcome research of individuals with Parkinson's disease after unilateral pallidotomy is inconsistent. Although some studies reported few cognitive changes, other investigations have more consistently shown both transient and long-term cognitive decline postoperatively.

Methods: We report the long-term motor and neurocognitive outcome 5 years post surgery for 18 patients with Parkinson's disease (12 men and 6 woman; all right-handed) who underwent right or left unilateral posteroventral pallidotomy.

Results: Pallidotomy patients revealed long-term motor benefits from the surgery in their "off" state and control of dopa-induced dyskinesias in their "on" state, which is consistent with previous research. We found mild declines in oral and visuomotor information processing speed, verbal recognition memory, and mental status 5 years after surgery, which differs from previous literature regarding the long-term neurocognitive outcome after pallidotomy. Differences between the right and left pallidotomy patients for both motor and cognitive skills were not found.

Conclusion: Although deep brain stimulation is presently the treatment of choice, pallidotomy continues to be performed around the world. Consequently, although unilateral pallidotomy should be considered a treatment option for patients with Parkinson's disease who suffer from severe unilateral disabling motor symptoms or dyskinesias, the long-term neurocognitive outcome should also be considered in treatment decisions.

MeSH terms

  • Adult
  • Aged
  • Cognition Disorders / diagnosis
  • Cognition Disorders / etiology
  • Cognition Disorders / physiopathology*
  • Female
  • Follow-Up Studies
  • Functional Laterality / physiology
  • Globus Pallidus / anatomy & histology
  • Globus Pallidus / surgery
  • Humans
  • Male
  • Memory Disorders / diagnosis
  • Memory Disorders / etiology
  • Memory Disorders / physiopathology
  • Mental Processes / physiology
  • Middle Aged
  • Neuropsychological Tests
  • Outcome Assessment, Health Care / methods
  • Pallidotomy / adverse effects*
  • Pallidotomy / methods
  • Pallidotomy / statistics & numerical data*
  • Parkinson Disease / complications
  • Parkinson Disease / physiopathology*
  • Parkinson Disease / surgery*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / physiopathology*
  • Postoperative Complications / psychology
  • Psychomotor Performance / physiology
  • Reaction Time / physiology
  • Retrospective Studies
  • Risk Assessment
  • Time Factors
  • Treatment Outcome