Parkinson’s disease (PD) is a chronic neurological disorder characterized by tremors, muscle rigidity, and bradykinesia, primarily affecting individuals over 40. While levodopa-based therapies are commonly used, their efficacy diminishes over time, often causing severe side effects. Pallidotomy, specifically posteroventral pallidotomy (PVP), has emerged as an effective surgical intervention to alleviate PD symptoms and reduce levodopa-induced complications. This procedure targets the overactive globus pallidus internus (GPi), which excessively inhibits motor thalamus and brainstem activity. However, due to the proximity of critical structures like the optic tract and internal capsule, precise surgical targeting using microelectrode-guided electrophysiological mapping is essential. Effective perioperative nursing care ensures patient safety, minimizes complications, and optimizes outcomes.
Preoperative Care
- Psychological Support
- PD patients often experience anxiety due to prolonged suffering and high expectations. Nurses address fears of pain, complications, or unsatisfactory results through empathetic communication and detailed explanations of the procedure. Learn more about PD surgical options.
- Training for Intraoperative Cooperation
- Visual Stimuli Response: Patients are trained to report flashes of light during microelectrode stimulation, aiding precise targeting. Preoperative nurse-led training reduces intraoperative time by 5–10 minutes compared to intraoperative physician explanations.
- Visual Field Monitoring: Patients learn to identify visual changes to avoid optic tract injury.
- Preoperative Preparations
- Static-Free Clothing: Cotton garments prevent signal interference during electrophysiological mapping.
- Medication Management: Discontinue PD medications 12 hours pre-surgery to unmask symptoms for intraoperative assessment.
- Postoperative Medication: Ensure patients bring levodopa (e.g., Madopar) for immediate postoperative use.
- Non-Verbal Communication: Train speech-impaired patients to use gestures or body language.
Intraoperative Care
- Surgical Process
- Conducted under local anesthesia, PVP involves:
- Imaging Localization: MRI-based anatomical targeting.
- Microelectrode Mapping: Functional targeting within 100μm accuracy via stimulation and impedance testing.
- Radiofrequency Lesioning: Precise ablation of the GPi.
- Conducted under local anesthesia, PVP involves:
- Patient Comfort and Safety
- Relaxation Techniques: Use music and conversation to reduce anxiety.
- Symptom Management: Address intraoperative spasms with therapeutic massage (e.g., lumbar/leg cramp relief).
- Vital Sign Monitoring: Track blood pressure, pulse, respiration, and SpO₂ every 5 minutes; maintain mean arterial pressure <12 kPa to prevent hemorrhage.
- Postoperative Mobilization
- Immediate Ambulation: Encourage walking post-surgery to boost confidence. Explore PD rehabilitation strategies.
Postoperative Care
- General Care
- Elevated Head Positioning: Reduces cerebral edema.
- Fever Management: Address postoperative absorption heat promptly.
- Psychological and Functional Rehabilitation
- Realistic Expectations: Emphasize that surgery alleviates rigidity/tremors but not structural issues (e.g., joint deformities).
- Exercise Advocacy: Promote daily functional training to maximize recovery.
Discharge Guidance
- Medication Adherence: Highlight the synergy of surgery and pharmacotherapy. Avoid high-protein diets to optimize drug absorption.
- Lifestyle Adjustments: Encourage low-impact exercises, balanced nutrition, and mental wellness.
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