Surgery for Parkinson's disease

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Abstract

Many patients are suitable for stereotactic surgical procedures for their Parkinson's disease (PD), but careful selection and follow-up are needed. Drug-resistant disabling tremor responds well to stereotactic thalamotomy of the ventrointermedius nucleus. Chronic neurostimulation of the ventrointermedius nucleus is an effective alternative, but probably has a lower morbidity rate, especially when implanted bilaterally. Tolerance is a minor problem. Staged bilateral posteroventrolateral pallidotomy is indicated in advanced PD with severe on-off fluctuations, peak-dose dyskinesia, and dystonia. Significant global improvements, particularly in the dyskinesia, are to be expected. Complications of destructive procedures are minimal if the lesion is accurately placed and the size controlled, but morbidity rates increase in bilateral procedures or elderly, cognitively impaired, and physically disabled patients. Surgery should be carried out in specialized centers with a strong multidisciplinary approach, and where the necessary technical expertise is available to ensure accuracy and therefore minimal morbidity. This particularly pertains to the use of physiologic guidance in all of these cases. Independent assessment of results is essential, and a randomized prospective study of bilateral pallidotomy is indicated. Radiosurgical treatment of PD is controversial and lacks physiologic control. Chronic neurostimulation of extrathalamic targets and neural transplantation remain experimental. The role of surgery in early PD has yet to be defined. Gene therapy holds promise but is in a very early phase of development.

Original languageEnglish
Pages (from-to)49-58
Number of pages10
JournalNeurosurgery Quarterly
Volume9
Issue number1
Publication statusPublished - 1 Mar 1999
Externally publishedYes

Keywords

  • Movement disorder
  • Pallidotomy
  • Parkinson's disease
  • Stereotactic surgery
  • Thalamotomy
  • Transplantation

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