Andres M. Lozano

Target Localization in Movement Disorders Surgery

The success of a stereotactic neurosurgical procedure is influenced by a number of factors. Proper patient selection is important in order to avoid treating patients unlikely to benefit from the procedure. Careful preoperative evaluation should identify factors that may result in avoidable complications or a difficult postoperative course. When surgery is deemed appropriate, the choice of anatomic target and method of treatment (lesion vs deep brain stimulation [DBS]) are the next major determinants of outcome.

Surgical Therapy for Parkinson's Disease

Publisher Summary This chapter reviews the surgical options for treating Parkinsons disease (PD) and summarizes the indications, anatomical targets, and surgical techniques. The relevant anatomy and pathophysiology and the proposed mechanisms of action of deep brain stimulation (DBS) are discussed. The evidence supporting the use of surgical therapy for PD is discussed. The focus of this chapter is on DBS as it is currently the most commonly used modality in movement-disorder surgery. Before the development of DBS, lesioning procedures were the standard surgical approach to treat movement disorders. The purpose of DBS is to disrupt the abnormal neuronal activity underlying PD and reestablish more normal motor function. Surgical therapy for PD has developed from an understanding of the functional neuroanatomy of the cortical-basal ganglia–thalamic-cortical circuit and the pathophysiology of movement disorders. The chapter discusses the mechanism of action and operative procedure of DBS, intraoperative electrophysiological mapping, and complications and adverse effects of deep brain stimulation surgery. Surgical therapy for PD has made significant advances with the emergence of DBS. A substantial proportion of levodopa-responsive PD patients may benefit from adjunctive therapy with DBS. The primary DBS targets for PD are the subthalamic nucleus (STN), globus pallidus (GPi), and ventral intermediate nucleus of the thalamus (Vim). Because of its adjustability and reversibility, DBS can be tailored to optimize its effects for each patient. To realize the potential benefits of DBS for PD, an experienced and knowledgeable team of movement disorder specialists is necessary.