Objective: Malta has a population of just under 450 000. The estimated number of patients likely to benefit from functional neurosurgery including Deep Brain Stimulation (DBS) is around 5 to 10 per year. The aim behind this study is analyse patients referred for functional neurosurgery since the introduction of the service locally.
Background: Functional Neurosurgery for movement disorder patients has been introduced locally in 2011. This service was initially reserved for deep brain stimulation in the setting of Parkinson’s disease. However, along the years, functional neurosurgery has expanded further. Thalamotomies and pallidotomies have been introduced as ablative surgeries aimed at treating movement disorders.
Method: Patients referred for functional neurosurgery at Mater Dei Hospital between 2011 and 2019 were recruited. Redo procedures were also included. Data was collected retrospectively from local databases. Data collected included patient demographics, diagnosis, indications for surgery, laterality of surgery, surgery proposed and suitability for surgery, details of surgery and reasons of forgoing surgery. Microsoft Excel was used for data inputting and analysis.
Results: Between 2011 and 219, a total of 116 patients were referred for functional neurosurgery, the majority of which were males (M=65.5%). The average age at the time of referral was 59.44 +/-1.13 years. Indications for surgery included Parkinson’s disease; 71%, Parkinson’s disease and essential tremor; 4%, Rubral tremor; 5%, Essential tremor; 3%, Cervical dystonia; 3% and others; 14%.
patients (92.4%) were referred for DBS implantation, whilst 7% were referred for thalamotomy and 1% of patients were offered surgical pallidotomy. Procedure was performed in 62% of patients. Reasons for forgoing surgery including patient co-morbidities such as dementia, patient preference and refusal, ongoing significant psychiatric disorders, and surgical referral at early stages of disease with sub-optimisation of medical therapy.
Conclusion: Functional neurosurgery is an ever-growing field worldwide and this was also reflected in our study. The introduction of further surgical procedures locally, apart from DBS, has recruited more patients suffering from movement disorders. The multidisciplinary approach and regular follow ups of patients ensures adequate referrals of patients for invasive surgical therapies.
To cite this abstract in AMA style:M. Bonello, J. Aquilina. A retrospective analysis of Movement Disorder Patient Referrals for Functional Neurosurgery in the Neurosciences Department of Mater Dei Hospital [abstract]. Mov Disord. 2021; 36 (suppl 1). https://www.mdsabstracts.org/abstract/a-retrospective-analysis-of-movement-disorder-patient-referrals-for-functional-neurosurgery-in-the-neurosciences-department-of-mater-dei-hospital/. Accessed December 1, 2023.
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