This booklet will provide information about the following
Preparing for Surgey
surgical procedures: Pallidotomy and Thalamotomy.
Before Admission to Hospital What is a Pallidotomy?
1) Anticoagulants (e.g. coumadin) and other medications
A pallidotomy is an operation for Parkinson’s disease where
that thin your blood, e.g. Aspirin, Ticlid, Plavix, Ginkgo
a small lesion is made in the globus pallidum (an area of the
must be discontinued 2 weeks before your surgery.
brain involved with motion control). The lesion is made by
2) Since you will be having a MRI, it is important to inform
an electrode placed in the brain through a small opening
your neurosurgeon if you are claustrophobic, have metal
in the skull. The beneﬁcial effects are seen on the opposite
fragments in your eye or have a pacemaker.
side of the body, i.e. a lesion on the left side of your brain
will help to control movement on the right side of your
Admission to Hospital
body. Pallidotomy will help reduce dyskinesia (medication
Your surgeon’s ofﬁce will contact you the day before your
induced writhing), and will also improve bradykinesia
scheduled surgery to conﬁrm the time to report to the Jim
If you are being admitted on a Sunday or on a holiday
Risks include a rare chance of death (0.2%) and a low
Monday, please call the Admitting Department of
chance (7%) of weakness or blindness on the opposite side
Vancouver Hospital at (604) 875-4300 after 10:00 a.m. the
day before your operation to ﬁnd out when you are to come
What is a Thalamotomy? The Night Before Surgery
A thalamotomy is an operation for tremor where a small
Whether you are in the hospital or at home, your
lesion is made in the thalamus. The lesion is made with
preparation for surgery the night before is the same. Before
an electrode placed in the brain through a small hole in
going to bed, shower and shampoo with a medicated soap
the skull. The beneﬁts (approximately 80% reduction in
that will help prevent infection. Pallidotomy patients will
tremor) are seen on the opposite side of the body, i.e. a left
stop their Parkinson’s medications 12 hours before surgery.
thalamotomy reduces tremor in the right hand.
This will make you stiff but will help keep you still for the
operation. Thalamotomy patients should not take their
tremor medications on the morning of surgery. This will
Risks include a rare chance of death (0.2%) and a low
help us see the tremor and know if we have blocked it
chance (10%) of weakness, incoordination, speech and/or
The Morning of Surgery The Operating Room
You will have an intravenous (IV) line started in your arm.
Hospital escort will take you to the Preoperative area. A
This IV line will provide you with ﬂuids that you would
nurse will admit you and you will wait there on the stretcher
normally get from drinking. You will be given all your other
until the operating room is ready. A family member or friend
medications (e.g. blood pressure pills) with a sip of water
may wait with you in the Preoperative area.
the morning of surgery. Do not take your Parkinson’s
The nurse who will care for you during your surgery will
or tremor medications until after surgery.
take you to the operating room. Your Neurosurgeon with a
When it is time for your surgery, hospital escort will take
Neurosurgical Fellow or Resident will perform your surgery.
you on a stretcher to the x-ray department where your
You will lie comfortably on the table with your head in a
neurosurgeon will attach a frame securely to your head
secure headrest to prevent any movement during surgery. A
(see diagram below). Your scalp will be injected with a local
small patch of hair will be shaved and the area cleaned with
anaesthetic (freezing). You will feel a pinprick and slight
antiseptic. Your neurosurgeon will inject local anaesthetic
burning. Once the freezing takes effect, the frame will be
(freezing). Once the freezing has taken effect a small
placed around your head. Four pins will anchor the head
incision will be made in your scalp and a tiny hole drilled in
frame to your skull. You will feel a tight squeeze as the
the bone. You will hear the sound of the drill but you will
frame grips the skull then (after a few minutes) you will not
not experience any pain. Most people are nervous about the
feel the frame at all. You will wear this frame until the end
drilling but soon realize it is loud but painless.
of your surgery and we will use it to keep your head still.
Once your neurosurgeon has found the target area within
Once the frame is secured, you will undergo an MRI scan.
the brain, he will ask you questions to make sure it is
Following the MRI scan you will be taken to the Operating
exactly the right spot. This is why you will be awake during
the entire operation. Pallidotomy patients are tested for
potential side effects such as ﬂashing lights or hand/face
tightness. Tremor patients will be tested to see if a test
lesion blocks the tremor sufﬁciently without causing side
effects such as hand/face tightness. Recovery Room Commonly Asked Questions
After your operation, you will be taken to the Recovery
Room. You will stay here for an average of 1-2 hours.
1) Do neurosurgeons routinely perform this operation?
Your blood pressure (BP), pulse, level of consciousness,
This procedure is routinely performed by Neurosurgeons
and motor strength will be monitored. Your nurses will be
with expertise in functional neurosurgery. Vancouver
assessing your motor strength by asking you to do certain
Hospital & Health Sciences Centre is the only centre
tasks such as wiggling your toes, pushing down and pulling
in B.C. performing this operation. This surgery is
back with your feet, and squeezing the nurse’s ﬁngers
performed regularly throughout the year.
with your hands. Your nurses will check your level of
consciousness by asking such questions as: your name, the
2) Do I need to discontinue my medication before
date, the year, and where you are. They will also check your
eyes with a small ﬂashlight to see what size your pupils are
Anticoagulants (coumadin) and other medications that
thin your blood, e.g. aspirin, Ticlid, Plavix, Ginkgo must be discontinued two weeks prior to surgery and may be
From the Recovery Room, you will be taken to the Nursing
3) Is the procedure painful?
Unit. Your nurse will admit you and continue to assess you
No. The scalp is frozen with a local anaesthetic before
regularly just as in the Recovery Room. Your neurosurgeon
the skin incision and tiny hole is made.
will see you and discharge you home the morning after your
surgery. You will be able to resume your normal activities
4) Will I be awake during the procedure?
but it is not unusual to feel tired for several weeks from
Yes. Your neurosurgeon will ask you questions during the
the operation. You may have temporary slurred speech or
procedure to help localize the brain target.
imbalance for a week or two after surgery. Once the swelling
5) Is this operation a cure for my Parkinson’s disease?
settles around the operativesite, these symptoms will go away.
No. The operation will control symptoms; it does not
Stitches: Please make an appointment with your family
doctor to have the stitches removed one week after your
surgery. You may wash your hair the day after the stitches
6) Will surgery interfere with other treatments/cures
are removed. If you experience weakness, speech diﬁculty,
that may be available in the future?
or notice any redness, swelling or discharge from the
incision, please call your neurosurgeon’s ofﬁce.
7) How does the small hole in my head heal?
The bone will reform over time but you may always will
Follow Up Appointment
Your ofﬁce visit is usually six to eight weeks after surgery.
Please phone to arrange an appointment.
8) When will I be able to dye my hair, swim and use a hot tub? After the stitches are removed.
For more copies, go online at http://vch.eduhealth.ca or
email email@example.com and quote Catalogue No. FM.223.P35
Vancouver Coastal Health, December 2008
The information in this document is intended solely for the
person to whom it was given by the health care team.
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