Radiosurgery for movement disorders

Figures & data

Table I.  Series of SRS for movement disorders.

	N° patients	Bilateral	Disease	Target	Symptoms	Procedure	SRS	Dose (Gy)	Isodose, cone
Lindquist et al., 1991 [27]	1	No	PD	VIM	Tremor	Thalamotomy	GK	180	100%, 8 mm
Rand et al., 1993 [28]	18 (8 + 10)	No	PD + ES	GPi + VIM	Rigidity + bradykinesia + tremor	Pallidotomy + thalamotomy	GK
Otsuki et al., 1994 [40]	1	No	PD		Tremor + hallucination	Thalamotomy	GK
Friehs et al., 1995 [41]	12 (10 + 2)	Yes°	PD	AntC+ VIM	Bradykinesia (10) + tremor + rigidity	Caudotomy (10) + thalamotomy	GK	160	100%, 4 mm
Pan et al., 1996 [42]	8	No	PD	VIM	Tremor + bradykinesia	Thalamotomy	GK	160–180	100%, 4 mm
Ohye et al., 1996 [19]	6	Yes (3)	PD	VIM	Tremor	Thalamotomy	GK	140–150	100%, 4 mm
Friedman et al., 1996 [35]	4	No	PD	GPi	Bradykinesia	Pallidotomy	GK
Bonnen et al., 1997 [21]	1	No	PD	GPi	Pallidotomy	Pallidotomy
Duma et al., 1998 [31]	34	Yes (4)	PD	VIM	Tremor	Thalamotomy	GK	110–165	100%, 4 mm
Young et al., 1998 [33]	55 (27 + 28)	Yes (4 bil. pallid.)	PD	VIM; GPi	Tremor + rigidity + bradykinesia + L-DOPA dyskinesia	Thalamotomy + pallidotomy	GK	120–160	100%
Young et al., 2000 [32]	158 (9 LFU)	No	PD + ET + others	VIM	Tremor	Thalamotomy	GK	120–160	100%, 4 mm
Niranjan et al., 2000 [34]	12	No	ET + MS	VIM	Tremor	Thalamotomy	GK	130–150	100%, 4 mm
Okun et al., 2001 [43]	8	No	PD	VIM	Tremor + bradykinesia	Thalamotomy	GK	100-200
Ohye et al., 2002 [18]	53 (23 LFU)	Yes	PD + ET + others	VIM + VO	Tremor + rigidity	Thalamotomy	GK	130	100%, 4 mm
Keep et al., 2002 [38]	1	No	PD	STN	Dyskinesia + bradykin.	Subthalamotomy	GK	120	100%, 4 mm
Ohye et al., 2005 [30]	51	Yes (9 + 5)*	PD + ET + others	VIM	Tremor + rigidity	Thalamotomy	GK	130	100%, 4 mm
Mathieu et al., 2007 [44]	6	No	MS	VIM	Tremor	Thalamotomy	GK	130–150	100%, 4 mm
Kondziolka et al., 2008 [17]	31 (5LFU)	No	ET	VIM	Tremor	Thalamotomy	GK	130–140	100%, 4 mm
Stancanello et al., 2009 [16]	1	No	Dystonia	GPi	Dystonia	Pallidotomy	CK	120	65%, 6.1 mm

LFU= lost on follow-up; *= 9 had conventional surgery on one side + SRS on the contralateral side, 5 had bilateral SRS; °= caudatus bilateral.

Figure 1. Direct identification of subthalamic nucleus (STN) on T2 TSE coronal 3-T MR images (A and B) and of the nucleus ventralis intermedius (VIM) on TSE dual-echo axial DP 3-T MR images (C and D).

Figure 2. The 3D beam distribution (upper left) and the axial (upper right), sagittal (lower left) and coronal (lower right) views of the pallidotomy case treatment plan visualized on the patient T2-weighted MRI volume.

Figure 3. Translations and rotations of the skull of the pallidotomy patient during treatment delivery. These values were fed into the system to realign the therapeutic beam and aim at the target during treatment delivery.

Figure 4. T2-weighted MRI axial (upper left), sagittal (upper right) and coronal (bottom) slices of the pallidotomy patient acquired 6 months post-treatment. The planned dose distribution (solid black lines; starting from the inside, these are the 120 Gy, 80 Gy and 40 Gy isodose lines) and the dose gradients (arrows) are also superimposed, allowing for a qualitative estimation of the clinical accuracy and related dose gradients of the treatment.

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