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Thalamotomy is the precise destruction of a tiny area of the brain called the thalamus that controls some involuntary movements. Before surgery, detailed brain scans using a CT scan or MRI are done to identify the precise location for treatment.
The person is awake during the surgery, but the scalp area where instruments are inserted is numbed with a local anesthetic. The surgeon inserts a hollow probe through a small hole drilled in the skull to the target location. An extremely cold substance, liquid nitrogen, is circulated inside the probe. The cold probe destroys the targeted brain tissue. The probe is then removed, and the wound is closed.
Surgery on one side of the brain affects the opposite side of the body. If you have tremor in your right hand, for instance, the left side of your brain will be treated. The procedure can be repeated on the other side of the brain if needed, but it greatly increases the risk of speech and cognitive problems after surgery.
Thalamotomy has very limited role in the present scenario for PD surgery. It is only useful in relieving Parkinsonian tremor. This tremor is typically described as "Peel rolling" tremor. In advanced cases postural and intentional components also become apparent. Tremor is a presenting symptom in majority of PD patients. In eight out of ten patients it is well controlled with drug therapy. Surgery is indicated only in resistant cases. Thalamotomy is not effective in alleviating other symptoms, like rigidity, bradykinesia and postural instability seen in PD patients. For the treatment of these symptoms we need to use other surgical targets. When undertaking thalamotomy or thalamic stimulation, it is important to realize this and educate the patient and physician about the need for continuous medical management of other Parkinsonian symptoms following surgery.
Risks
This type of brain surgery is less risky today than it was in the past because technology allows the surgeon to identify with great precision the area of the brain that will be treated. Serious, permanent complications are uncommon.
Complications of thalamotomy can include : -
Weakness, loss of sensation, or loss of voluntary movement (paralysis).
Temporary confusion.
Stroke caused by bleeding in the brain, which sometimes can lead to death.
Temporary balance problems.
Numbness around the mouth (leading to drooling) and in the hands.
Infection.
Seizures.
Temporary balance problems.
Uncontrollable, tiny running steps when walking (festinating gait).
Loss of muscle tone.
Impaired speech. This is much more likely when surgery is done on both sides of the brain.
Problems with thought and memory (cognitive impairment).
its quality treatment and advanced technology and it is popularly known for its care and treatment. With the use of advanced medical technology and newly invented techniques the recovery time after surgery is shortened and within very short period time frame patients becomes fit and return back to work.
Thalamotomy, a surgical intervention for the treatment of various forms of movement disorders such as Parkinson's disease, tremor, and dystonia, is a procedure that severs nerve fibers from an area of the brain called the thalamus. Thalamotomy is effective in treating tremor, but has little or no effect on akinesia or bradykinesia. For Parkinson's disease patients with symptoms other than tremor, pallidotomy is preferred over thalamotomy. It is not surprising that both thalamotomy and pallidotomy have similar effects on tremor since the thalamic ventral nuclear group receives efferent projection from the globus pallidus.
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