In conclusion, the single most consistent result of unilateral pallidotomy is the resolution of contralateral dyskinesia and so this therapy is best reserved for those few patients who exhibit asymmetrical disabling dyskinesia and whose level of parkin-sonism is unacceptable when the medication is reduced.
In general, the thalamic target has been largely abandoned in the surgical management of PD. Unilateral thalamotomy could be considered for those few patients who exhibit asymmetrical long-standing tremor that is unresponsive to maximum tolerated doses of medication and who have few or nonprogressive signs of parkinsonism, or for patients who have required repeated battery changes following unilateral stimulation of the Vim nucleus. It should be noted that these groups comprise only a small minority of patients with advanced PD in whom the signs are typically bilateral and progressive. In this situation, currently the optimal therapy is bilateral DBS of the STN or internal pallidum, although the STN is generally favored. Bilateral pallidotomy and thalamotomy are rarely performed due to concerns about postoperative speech and cognitive decline. The role of unilateral and bilateral lesions of the subthalamic region remains to be established.
Few data are available on long-term follow-up and lesion site, size, the inclusion of external pallidum, ansa lenticularis, Voa/Vop, STN, peri-STN structures, the need for microelectrode recordings, and the safety and efficacy of bilateral lesions all remain important and controversial issues in the field of lesion surgeries.
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