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A pallidotomy is a surgical procedure in which part of the globus pallidus, an area of the brain located within the basal ganglia, is damaged so that it cannot function. As the suffix “-otomy” suggests, a pallidotomy is performed by cutting into the brain with a specialized probe to access the area of interest. This procedure can be very risky, and it is only performed when it is the best option available for the patient.
One might reasonably ask about the circumstances in which destroying part of the brain would be deemed an acceptable treatment for a patient. Pallidotomies are performed on patients with Parkinson's disease. This disease is characterized by shaking and uncontrolled movement. In the early stages, the shaking can be controlled with medications which suppress the actions of cells in the globus pallidus, reducing the shaking. When these medicines stop working, it may be necessary to damage some of the cells to stop them from firing.
During the pallidotomy, the patient is awake. The patient is kept awake because it is important for the surgical team to get feedback from the patient as the probe is placed. Before the surgery, detailed scans of the brain are taken so that the surgeon knows where to go, and the patient's head is placed in a frame which keeps it completely still. As the probe is inserted, the team gets feedback from the patient to confirm that the probe is in the right place, and once it is placed, the pallidotomy can be performed.
If the movement issues are limited to one side of the body, a unilateral pallidotomy will be performed to address only the side which is involved. If the whole body is involved, a bilateral pallidotomy will be performed. Both require the placement of burr holes in the skull to access this area of the brain. Recovery in the hospital after the procedure takes several days, and the patient needs several weeks of recovery at home.
One potentially serious complication of this procedure is a stroke caused by bleeding in the brain, which may lead to additional complications in the future. The surgeon also runs the risk of damaging other areas of the brain. Because of these risks, deep brain stimulation is a popular alternative to pallidotomy, as it is much less dangerous. After the surgery, a neurologist will follow up with the patient to confirm that the procedure was successful, and to identify any signs of troubling complications.