Surgery Overview

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 treatment.

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.

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 surgery.

What To Expect

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.

How Well It Works

Thalamotomy may help tremor. There is no evidence it works for other symptoms of Parkinson's disease.^{footnote 1}

Risks

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 include:

• Weakness, loss of sensation, or loss of voluntary movement (paralysis).
• Temporary confusion.
• Stroke caused by bleeding in the brain, which sometimes can lead to death.
• Temporary balance problems.
• Numbness around the mouth (leading to drooling) and in the hands.
• Infection.
• Seizures.
• Uncontrollable, tiny running steps when walking (festinating gait).
• Loss of muscle tone.
• Impaired speech. This is much more likely when surgery is done on both sides of the brain.
• Problems with thought and memory (cognitive impairment).