Radiofrequency brain lesioning surgery

Radiofrequency brain lesioning surgery is primarily performed to treat Parkinson's disease, dystonia, tremor and psychological diseases. Radiofrequency is a type of high-frequency radio wave that can be used to create a lesion. The waves are passed through a probe in the brain that's used to target the correct tissue. It is done under local anesthesia (you aren't put to sleep), but because brain tissue feels no pain, the procedure is essentially painless. It is important for the patient to be awake during the procedure so that the surgeon can ask the patient a series of questions and perform a series of tests to localise the part of the brain causing the tremor or rigidity. These lesions target cells that control movement and are used to treat movement disorders, such as essential tremor, Parkinson's disease, and dystonia.

You might have lesioning to treat Parkinson's disease if you have severe tremors (especially on one side), stiffness, or movement difficulties that are no longer controlled with medication, or serious motor problems from long-term use of levodopa (L-dopa). In those with essential tremor, propranolol and primidone are frontline treatments that reduce tremors for 50 to 60 percent of people. Lesioning might be an option if these medications don't work, or the side effects are too severe.

Before surgery, your doctor will use an MRI or CAT scan to create a 3-D model of your brain. This allows them to see exactly what area of the brain to target. Your doctor might also use a procedure called microelectrode recording to detect how the cells in your brain fire. This helps them narrow down the target even more.

There are several different types of lesioning surgery. Those for Parkinson's disease and movement disorders include: - **Pallidotomy.** In this procedure, surgeons make a lesion in the Globus pallidus, a part of the brain that's overactive in Parkinson's disease. This surgery is not a good option for people with Parkinson's disease who don't respond well to L-dopa.

- **Thalamotomy.** This procedure is mostly used for dystonia that affects one side of the body, or Parkinson's tremors on one side of the body. It targets the thalamus, a part of the brain that helps control motor responses. Thalamotomy is not used for bradykinesia, speech problems, or walking problems.

- **Subthalmotomy.** This procedure targets the subthalamus, a small area of the brain that plays a role in motor control. It's the rarest type of lesioning.

In psychological disorders the lesion is usually made at bilateral sites. The most common targets include: - **Anterior Cingulotomy.** Posterior to anterior — most tip of frontal horn. Most commonly performed in North America for obsessive-compulsive disorder (OCD). Also used in treatment of pain and major depression.

- **Anterior Capsulotomy.** The target is the anterior limb of internal capsule at the border between putamen and pallidum, halfway between frontal horn tip and foramen of Munro. An effective and safe technique for the treatment of severe refractory OCD in patients who have no other alternative to improve their symptoms.

- **Amygdalatomy.** Bilateral amygdala radio-frequency ablation effective for refractory aggressive behaviour that alters local cortical activity.

Common, but temporary, side effects of stereotactic thalamotomy include confusion, weakness, disturbed speech, balance problems, infection, and bleeding.