Dual-Target Stereotactic Lesioning in Parkinson’s Disease: Safety and Efficacy Compared to Single-Target Approaches

Stereotactic lesioning has re-emerged as a feasible option to deep brain stimulation (DBS) for severe Parkinson's disease (PD), especially in individuals with restricted access to device-based therapy. Although single-target lesioning of the ventral intermediate nucleus (Vim) or globes pallidus internus (GPi) effectively addresses certain motor disorders, dual-target lesioning within the same hemisphere is yet little investigated. To assess the effectiveness and safety of dual-target stereotactic lesioning (Vim + GPi) against single-target lesioning (Vim or GPi alone) in individuals with advanced Parkinson's disease and medication-resistant motor symptoms. A prospective observational research with 450 consecutive patients with advanced Parkinson's disease was carried out at two neurosurgical centers in Iraq. Patients underwent either single-target (n = 321) or dual-target (n = 129) radiofrequency lesioning. Outcomes were assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS-III) and complication rates over a follow-up period of 1–2 years. Statistical comparisons were made using t-tests and p-values < 0.05 were considered significant. Dual-target lesioning yielded significantly greater improvement in tremor (↓ 85.7%), rigidity (↓ 75.7%), and bradykinesia (↓ 82.4%) compared to single-target approaches (all p < 0.0001). However, complication rates were higher in the dual-target group, particularly for speech (27.1% vs. 13.1%, p = 0.0016) and balance disturbances (37.2% vs. 17.1%, p < 0.0001). No notable variations were detected in age, illness duration, or baseline LEDD across the groups. In comparison to single-target ablation, dual-target stereotactic lesioning is associated with a higher incidence of adverse effects; nevertheless, it is significantly more successful in managing motor symptoms in advanced Parkinson's disease (PD). The meticulous selection of patients and the adjustment of lesion characteristics are essential to enhance benefits while concurrently limiting issues. In individuals unsuitable for deep brain stimulation (DBS) or seeking more comprehensive symptom relief, these findings advocate for the targeted application of dual-target approaches.