Complications of gamma knife surgery for Parkinson disease

Michael S. Okun, Natividad P. Stover, Thyagarajan Subramanian, Marla Gearing, Bruce H. Wainer, Chad A. Holder, Ray L. Watts, Jorge L. Juncos, Alan Freeman, Marian L. Evatt, Stephan U. Schuele, Jerrold L. Vitek, Mahlon R. DeLong

Research output: Contribution to journalArticle

77 Scopus citations

Abstract

Background: Many medical centers throughout the world offer radiosurgery with the gamma knife (GK) for pallidotomy and thalamotomy as a safe and effective alternative to radiofrequency ablative surgery and deep brain stimulation for Parkinson disease (PD). The reported incidence of significant complications varies considerably, and the long-term complication rate remains unknown. Design: We describe 8 patients seen during an 8-month period referred for complications of GK surgery for PD. Results: Of the 8 patients, 1 died as a result of complications, including dysphagia and aspiration pneumonia. Other complications included hemiplegia, homonymous visual field deficit, hand weakness, dysarthria, hypophonia, aphasia, arm and face numbness, and pseudobulbar laughter. In all patients, lesions were significantly off target. Conclusions: The 8 patients with PD seen in referral at our center for complications of GK surgery highlight a spectrum of potential problems associated with this procedure. These include lesion accuracy and size and the delayed development of neurological complications secondary to radiation necrosis. Gamma knife surgery may have a higher complication rate than has been previously appreciated due to delayed onset and underreporting. We believe that the risk-benefit ratio of the GK will require further scrutiny when considering pallidotomy or thalamotomy in patients with PD. Physicians using this technique should carefully follow up patients postoperatively for delayed complications, and fully inform patients of these potential risks.

Original languageEnglish (US)
Pages (from-to)1995-2002
Number of pages8
JournalArchives of Neurology
Volume58
Issue number12
DOIs
StatePublished - Dec 2001

All Science Journal Classification (ASJC) codes

  • Arts and Humanities (miscellaneous)
  • Clinical Neurology

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    Okun, M. S., Stover, N. P., Subramanian, T., Gearing, M., Wainer, B. H., Holder, C. A., Watts, R. L., Juncos, J. L., Freeman, A., Evatt, M. L., Schuele, S. U., Vitek, J. L., & DeLong, M. R. (2001). Complications of gamma knife surgery for Parkinson disease. Archives of Neurology, 58(12), 1995-2002. https://doi.org/10.1001/archneur.58.12.1995