This case involves a 62-year-old female patient who developed left-side paralysis following a thalamotomy. She underwent a gamma knife thalamotomy for a longstanding essential tremor. The patient later developed left-side paralysis and was unresponsive to therapy and hyperbaric treatment. The patient continued to suffer from weakness and lack of control on the left side of her body and was unable to return to work.
Question(s) For Expert Witness
- 1. Please describe your background performing gamma knife thalamotomies.
- 2. What complications can occur when performing this procedure?
Expert Witness Response E-000572
Although I have performed 1,000+ gamma knife procedures, gamma knife thalamotomies are not very commonly performed. We tend to perform deep brain stimulation or stereotactic lesions since they have been found to be more advantageous. However, occasionally, patients are felt to not be good candidates for the other procedures and undergo gamma knife radiosurgery thalamotomy. Contralateral weakness is a known risk for all these procedures. This case will hinge on whether or not there were reasons why the patient needed to undergo gamma knife and avoid an open operation for DBS or stereotactic thalamotomy. Any information indicating whether the technique used as a violation of the standard of care will also be helpful.