Functional Neurosurgery (AAN)
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Moreover, the size of the lesion, or its distance from the wall of the third ventricle and the region around the lateral border of the thalamus on the posttreatment MRI scans, to indicate the exact size and location of the final target achieved, are also not mentioned.
All these factors greatly influence the occurrence of complications [ 3 ], and so drawing conclusions based on this incomplete description is erroneous. We frankly confess an unsettling curiosity for the reason behind such a callous elucidation of the RF thalamotomy procedure in this article. Another important concern about this article is the strikingly high incidence of complications reported in patients treated with RF thalamotomy as opposed to MRgFUS.
Besides, there exists a lack of discussion of the reasons for this inordinate occurrence of procedure-related complications.
Radiofrequency Thalamotomy for Drug-Refractory Essential Tremor
More than half of their patients undergoing unilateral RF thalamotomy developed complications during the first week postsurgery, which, in our opinion and experience, strongly suggests inaccurate mapping of the Vim nucleus coordinates or inadequate lesioning. Nevertheless, we maintain the perspective that a detailed elucidation of the Methods section is essentially important to convincingly insist on these significantly higher complication rates. At this point, revisiting the clarification of the procedure for intraoperative neurophysiological testing and confirmation of target location is warranted, since such a substantial incidence of procedure-related complications may imply that the procedure in fact proved futile.
At our center, we practice correct Vim nucleus coordinate mapping and careful observation, using macrostimulation under impedance monitoring which we consider essential for safe and effective RF thalamotomy. We routinely conduct Vim thalamotomy for drug-refractory ET but have never encountered the incidence of complications reported in their article [ 1 ]. We further stress the importance of watchful macrostimulation for the precise mapping of Vim nucleus coordinates to circumvent the reported complications.
Furthermore, this described high incidence of complications for RF thalamotomy at 1 week, 1 month, and 12 months after surgery would have been obtained from medical records since such procedures were performed only until , and so the reliability here is uncertain. MRgFUS is definitely a potential treatment modality for ET depending on the patient and disease factors, but it is still under trial for the evaluation of long-term results and validation.
The authors talk of RF thalamotomy being no longer in frequent use and its abandonment from the clinical field due to the high incidence of procedure-related complications.
American Academy of Neurology
However, RF thalamotomy has not been abandoned as stated in their article. Published guidelines from the American Academy of Neurology AAN in , updated in , recommend the use of unilateral thalamotomy for the treatment of limb ET that is refractory to medical treatment level C [ 6 , 7 ]. As rightly pointed out, this work is a retrospective review of medical records with a significant gap of over 10 years between RF thalamotomy and MRgFUS.
We unquestionably deduce that the formulation of the statements made by the authors based on insufficient information creates a misleading impression of RF thalamotomy in the field of functional neurosurgery around the world which cannot be endured. We have made a sincere attempt at correcting, or even preventing the creation of, this wrong impression precipitated and left on young minds by this article. We hope to provoke a sense of disbelief towards the bid to tarnish RF thalamotomy. Copyright: All rights reserved.
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