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Fm.223.p35 pallidotomy and thalamotomy.inddPallidotomy
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.
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
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 the operation?
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 Nursing Unit
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
After the stitches are removed.
For more copies, go online at http://vch.eduhealth.ca or
email firstname.lastname@example.org 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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