Thalamotomy is the precise destruction of a
tiny area of the brain called the thalamus that controls some involuntary
movements. Before surgery, detailed brain scans using a
CT scan or
MRI are done to identify the precise location for
The person is awake during the surgery, but the scalp
area where instruments are inserted is numbed with a local anesthetic. The
surgeon inserts a hollow probe through a small hole drilled in the skull to the
target location. An extremely cold substance, liquid nitrogen, is circulated
inside the probe. The cold probe destroys the targeted brain tissue. The probe
is then removed, and the wound is closed.
Usually, the outward symptoms of Parkinson's are distinctive enough for a doctor to make a diagnosis in the office. Tests can help your doctor determine whether you have Parkinson's disease or some other type of parkinsonism. If you don't have a response to the drugs used to treat Parkinson's disease, you may have one of these other types of movement disorders and your doctor will probably continue to search for the cause of your symptoms.
Surgery on one side of
the brain affects the opposite side of the body. If you have tremor in your
right hand, for instance, the left side of your brain will be treated. The
procedure can be repeated on the other side of the brain if needed, but it
greatly increases the risk of speech and cognitive problems after
What To Expect After Surgery
The surgery usually requires a 2-day
hospital stay. Most people recover completely within about 6 weeks.
Why It Is Done
Thalamotomy is rarely done today. It may be used to
treat severe tremor on one side of the body (most often in an arm or leg) that
does not respond to medicines. It does not help with slow movement
(bradykinesia), speech problems, or walking difficulties.
Thalamotomy usually is reserved for people younger than 65 who have
normal intellectual function and normal recent memory.
should not have this procedure are those who have:
shifts in voluntary motion of their arms, legs, and torso that affect their
walk and posture.
Thalamotomy may help tremor. There is no evidence it works for other symptoms of Parkinson's disease.1
This type of brain surgery is less risky today
than it was in the past. Technology allows the surgeon to identify with
great precision the area of the brain that will be treated. Serious, permanent
complications are uncommon.
Complications of thalamotomy can
Weakness, loss of sensation, or loss of
voluntary movement (paralysis).
Stroke caused by bleeding in the brain, which sometimes
can lead to death.
Temporary balance problems.
around the mouth (leading to drooling) and in the
Uncontrollable, tiny running steps when walking
Loss of muscle tone.
speech. This is much more likely when surgery is done on both sides of the
Problems with thought and memory (cognitive
What To Think About
Thalamotomy is rarely used. The
effectiveness, lower risk, and nondestructive nature of deep brain stimulation
have made it the preferred surgical method for treating Parkinson's disease.
Even for cases in which deep brain stimulation is not an option, thalamotomy is
used less often than pallidotomy, because pallidotomy can improve a broader
range of symptoms. Thalamotomy can reduce tremor, but it does not have
a strong effect on other symptoms of the disease or on involuntary movements
(dyskinesias) caused by long-term levodopa therapy.
may be considered as an addition to levodopa therapy, not as a replacement for
it. It does not cure Parkinson's disease and does not eliminate the need for
medicine. After surgery, treatment with levodopa will be continued and the
dose adjusted as needed.