The importance of accurate lesion placement in posteroventral pallidotomy

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Abstract
Pallidotomy has become a widely used treatment for medically refractory Parkinson's disease. However, the optimal lesion size and location within the pallidum have not yet been determined, and the role of repeated pallidotomy remains undefined. The authors present two patients who had unsatisfactory results after their first unilateral pallidotomy but attained dramatic and long-lasting improvement with repeated surgery. The results obtained in these cases indicate that patients who have a good clinical outcome initially but relapse rapidly after surgery should be considered for repeated pallidotomy if the initial lesion was not placed in the optimal location.