Simultaneous radiofrequency VIM thalamotomy and Posteroventral pallidotomy for management of dystonic tremors

Abstract

Introduction Dystonic tremors are a complex poorly understood uncommon types of tremors which are challenging to diagnose and often refractory to medical treatment, Botox injection has been used in selected DT cases and surgical treatment, mainly deep brain stimulations, has been used to treat severe cases however the role and effectiveness of surgery in treatment DT is still not well establishedAim of the workTo assess the efficacy and safety of surgical treatment of dystonic tremors through simultaneous posteroventral pallidotomy and VIM thalamotomy reporting the surgical procedure, clinical outcome and the complications. Patients and methods Nine patients with dystonic tremors with different etiologies has been surgically treated with simultaneous pallidotomy and thalamotomy three patients with primary dystonia, two with previous head injury, two with previous cerebrovascular stroke and one patient with postencephalitic secondary dystonia and one with DT secondary to Wilson’s disease Results All the nine patients improved significantly after surgery with mean improvement of 76% the highest improvement was in the patients with dystonic tremors with primary dystonia 91 % and the least with post stroke dystonic tremors patients 38% complications were mild and /or transient this improvement was maintained for all but one patient at 6 months follow up Conclusion Simultaneous pallidotomy and thalamotomy can offer an effective surgical treatment modality to treat dystonic tremors of different etiologies with relatively high safety and significant efficacy