Ablative surgery for Parkinson's disease: Is there still a role for pallidotomy in the deep brain stimulation era?

- Pallidotomy has a great profile of efficacy and safety when performed unilaterally.
- Pallidotomy can be a better option than DBS in individualized situations.
- The initial costs are the most limiting factor when choosing pallidotomy over DBS.
- Pallidotomy should remain in the therapeutic arsenal of Parkinson's disease.

Posteroventral pallidotomy has already been considered the surgical procedure of choice for Parkinson's disease patients with motor complications. Recently, however, several factors led to its replacement by deep brain stimulation. Nevertheless, pallidotomy has a well-documented efficacy and safety evidence regarding the reduction of parkinsonian motor symptoms. Yet, there may be manysituations where it may be considered as a better option than neuromodulation. Herein we review those possible conditions, giving emphasis to the costs, which we found to be the most limiting factor. Importantly, a cost comparison between deep brain stimulation and pallidotomy was also provided.