RESULTS OF 1,000 CONSECUTIVE BASAL GANGLIA OPERATIONS FOR PARKINSONISM

Abstract

This report is concerned with an evaluation of 1000 consecutive basal ganglia operations for parkinsonism performed between October, 1952, and April, 1959. The operations employed in these 1000 consecutive cases were chemopallidectomy or chemothalamectomy. Although the original surgical target in our experience was the mesial aspect of the globus pallidus, the evolution of this type of surgery on our service has demonstrated that the surgical target of choice for the relief of parkinsonian tremor and rigidity is the ventrolateral nucleus of the thalamus. During the past 2 years this portion of the thalamus has been the exclusive area of lesion production for the relief of tremor and rigidity. The single most important component of chemothalamectomy is the necessity of producing a reversible harmless lesion within the target area of the brain, the effects of which can evaluated in a conscious cooperative patient before any permanent lesion is inflicted. This clinical physiologic surgical test of the planned lesion is the absolute foundation upon which safe successful basal ganglia surgery is based. The use of a small inflatable balloon at the tip of our brain cannula, which produces a compressive effect upon the ventrolateral nucleus of the thalamus, serves to provide the physiologic test which is required in the conscious cooperative patient. The ultimate lesion is made by injection of an alcohol-pantopaque solution into the cavity produced by this balloon. Experience with these 1000 consecutive operations demonstrates conclusively that tremor, rigidity and deformity of parkinsonism can ve completely relieved by this type of surgery. Many 5-year cures of these particular symptoms are now demonstrable in the personal series of cases reported in this paper. Surgical therapy of parkinsonian tremor and rigidity is now indicated early in the course of the disease. Surgical therapy has the possibility of providing rapid and often complete relief of tremor, rigidity, deformity and the attendant motor symptoms of bradykinesia. In properly selected cases the likelihood of obtaining such a result is 80%. The mortality rate for the first 1000 consecutive operations is 2.4%. The incidence of hemiparesis or hemiplegia is slightly less than 3%.