Palidotomía unilateral y Subtalamotomía contralateral en dos tiempos quirúrgicos: Presentación de caso.

Nelson Ernesto Quintanal Cordero; Ivón Pedroso Ibáñez; Raisa Braña Miranda; Juan Teijeiro Amador; Raúl Macías González; Armando Abreu Duque; Randis Garbey Fernández

doi:10.47924/neurotarget202125

Authors

Nelson Ernesto Quintanal Cordero International Center for Neurological Restoration. (CIREN). Havana. Cuba. Neurosurgery Department. https://orcid.org/0000-0003-3812-5899
Ivón Pedroso Ibáñez International Center for Neurological Restoration. (CIREN). Havana. Cuba.
Raisa Braña Miranda International Center for Neurological Restoration. (CIREN). Havana. Cuba.
Juan Teijeiro Amador International Center for Neurological Restoration. (CIREN). Havana. Cuba.
Raúl Macías González International Center for Neurological Restoration. (CIREN). Havana. Cuba.
Armando Abreu Duque International Center for Neurological Restoration. (CIREN). Havana. Cuba.
Randis Garbey Fernández International Center for Neurological Restoration. (CIREN). Havana. Cuba.

DOI:

https://doi.org/10.47924/neurotarget202125

Keywords:

Parkinson's disease, pallidotomy, subthalamotomy, bilateral lesion, ablation, case report

Abstract

Introducción: For the surgical treatment of Parkinson's disease, performing a unilateral pallidotomy, followed by a contralateral subthalamotomy in a second surgical time, would avoid the complications derived from bilateral pallidotomy and may be a safe alternative for patients even when they present symptoms of dyskinesias.
Clinical case: The patient was a 38-year-old, with a 6 year history of idiopathic Parkinson's Disease featuring at the beginning tremor in the right upper limb. Slowly exhibited alterations in gait, posture, manipulative skills and motor fluctuations added to the picture. Subsequently, unilateral and severe levodopa-induced dyskinesias appear on the right side, performing a unilateral left posteroventral pallidotomy with a good response. Progressive involvement of the trunk and contralateral limb four years later, when she developed left biphasic and ON dyskinesias, as well as complex motor fluctuations and severe axial symptoms. A second pallidotomy was excluded because of the risk of complications. A contralateral subthalamotomy was performed, after that, the patient had a good response with a significant improvement in the motor symptoms and a total resolution of the dyskinesias.
There were no neurological complications due to the unilateral palidotomy or the combination of the Pallidotomy/Subthalamotomy in opposite cerebral hemispheres in the follow-up for 1 year, maintaining a good therapeutic effect throughout this period. There were no surgical complications in either of the two procedures. Conclusion: The combination of unilateral pallidotomy with contralateral subthalamotomy in this case, proved to be an effective alternative for the treatment of complicated Parkinson's disease, achieving a significant improvement in motor symptoms and a reduction in the dose of L-dopa, thus avoiding complications derived from bilateral pallidotomy and improving the quality of life of the patient.

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