Non-destructive pallidal disruption for management of Parkinsonism and a pre-DBS maneuver

Document Type : Original Articles


1 neurosurgery department, shebin elkom teaching hospital, menoufia, egypt

2 neurosurgery department, al-Azhar university, Cairo, Egypt


Background: The pallidum as a target for stereotactic surgery either by Lesioning or deep brain stimulation (DBS) plays an important role in the functional stereotactic neurosurgery. Deep brain stimulation (DBS) is a high cost method for treatment of Parkinsonism especially for low income countries like Egypt but it is reversible. On contrary, Ablation is a low cost method but it is irreversible.
Objectives: The aim of this study to introduce a novel application for mechanical pallidotomy by Air concussion and intermittent inflation and deflation for treatment of Parkinsonism and as a pre-DBS maneuver.
Methods: We operated on 6 patients. We injected 2ml of hypertonic saline through 5ml syringe at the pericapsular area using Leksell stereotactic frame
Results: 83.3% showed response to the maneuver. Only one patient (16.4%) showed no response.
Conclusions: Non-destructive pallidal disruption for management of Parkinsonism is a safe and effective transient maneuver. We are planning to apply microballoning and Air concussion technique to make it permanent and our future directions is to include more cases. We can use this maneuver as a pre-DBS stage to ensure the patient is a good candidate for DBS.