Leksell Radiosurgery for Movement Disorders.

Abstract

Tremor is the most prevalent movement disorder in adults. Patients who are refractory to medical management can explore surgical intervention. Deep-brain stimulation (DBS) and radiofrequency thalamotomy (RFT) are surgical procedures for intractable tremor that target the ventralis intermedius (VIM) nucleus to relieve contralateral tremor. For patients who are not candidates for surgical procedures, stereotactic radiosurgery (SRS) is a minimally invasive management option for tremor relief. SRS has been used for the elderly, those considered high surgical risk for other surgical procedures, those who are unresponsive to either DBS or RFT, and those who prefer a less invasive option. Radiosurgical thalamotomy is performed using a central dose of 130-140 Gy delivered to the VIM nucleus of the thalamus. The critical aspect of the dose planning procedure is the selection of the target, which requires a neurosurgeon experienced with movement disorder surgery. More than 90% of patients experience improvements in their tremor and quality of life after radiosurgical thalamotomy. Adverse radiation effects rates are low (4%). In selected cases, staged bilateral procedure can also be performed to relieve bilateral refractory tremor. In patients with tremor-predominant Parkinson's disease, VIM thalamotomy is also effective.