 |
 |
John Good review of the conference. I am concerned over the suggestion that Dr Teo has noted complications with a higher frequency than I, supposedly, have reported. I have never reported on our pallidotomy series in the literature but have written rather extensively on thalamotomy. You should realize that the beneficial effects and complications with any procedure are directly related to patient selection, the operative technique used and the postoperative care administered. The fact that Dr Teo has a slightly different incidence of complications than I do suggests that his technique may differ from mine: he uses a CRW frame, if he follows Iaconno's method,-I use Leksell or COMPASS systems which have less MRI distortion; he uses ventriculography -I don't for pallidotomy but do for thalamotomy, I use microelectrode recording-he doesn't. Patient confusion during recording or stimulation portions of the procedure is God telling me not to make a lesion. If he has determined that elderly patients don't do as well, that means he's done some elderly patients which will increase the morbidity. Also, if one doesn't carefully control thye patient's blood pressure postoperatively the result can be hemorrhage into a lesion. I've only had this happen once during my career(that was enough). Patient selection is critical-elderly patients with speach and swallowing problems are not the best candidates for any neuroablative procedure. Anyway great job of reporting on this talk-I agree with everything you have said Regards PJ Kelly \--------------------------------------------------------------\ \ Patrick Kelly, MD \ Internet: [log in to unmask] \ \ NYU Medical Center \ Phone: (212)-263-8002 \ \ New York, N Y \ \ \ \ \ \--------------------------------------------------------------\