Neurologists and neurosurgeons, working together, have championed innovations in neurosurgical care to address patients with movement disorders failing medical management.
This section of the International and Movement Disorder Society website is dedicated to elaborating on neurosurgical advancements in treating patients with movement disorders and was developed under the leadership of the former Director of the Neurosurgery Task Force of the International Parkinson and Movement Disorder Society, Prof. Joachim K. Krauss (Direktor, Neurochirurgie, Zentrum Neurologische Medizin, Medizinischen Hochschule Hannover, Germany). Special recognition for developing this content and coordinating the project belongs to Dr. Karl Sillay, Dr. Kelly Foote and Dr. Marwan I. Hariz.
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Definition of Stereotactic and Functional Neurosurgery
Neurosurgeons treating disorders of brain function by inactivating or stimulating the nervous system often referred to as functional neurosurgeons. Early neurosurgeons performing procedures with a Stereotactic Frame (described later) were often referred to as Stereotactic or Stereotaxic neurosurgeons. The term Functional and Stereotactic Neurosurgery has been associated with those neurosurgeons performing such procedures as deep brain stimulation (DBS).
More formally defined, "Stereotactic and Functional Neurosurgery is a branch of neurosurgery that utilizes dedicated structural and functional neuroimaging to identify and target discrete areas of the nervous system and to perform specific interventions (for example neuroablation, neurostimulation, neuromodulation, neurotransplantation, and others) using dedicated instruments and machinery in order to relieve a variety of symptoms of neurological and other disorders and to improve function of both the structurally normal and abnormal nervous system." (Blond, Broggi, Gildenberg, Hariz, Krauss, Lazorthes and Lozano).
Brief History of Neurosurgery for Parkinson’s disease
Surgical intervention for Parkinson's disease (PD) began with ablative surgery. In 1942, Dr. R. Meyers first reported the effects of ablative surgery of the basal ganglia in a Parkinson's patient when he performed partial caudate resections for control of parkinsonian unilateral tremor (Meyers, 1942; Gildenberg, 1998). In the 1950s, Dr. Cooper reported an accidental finding during a planned mesencephalic pedunculotomy. Dr. Cooper ligated the anterior choroidal in the process of aborting the surgery, and observed reduction in tremor and rigidity without the loss of motor strength. Lesions produced by this procedure variably included parts of the thalamus, globus pallidus, or internal capsule.
Human stereotaxy was introduced in 1947 by Spiegel and Wycis (Spiegel et al., 1947), providing a reproducible method of navigating to an intended surgical target. Dr. Hassler described lesioning of the ventral intermediate nucleus of the thalamus for parkinsonian tremor using stereotaxy in 1954 (Hassler and Riechert, 1954). Surgery for movement disorders was then widely performed until Dr. Cotzias introduced in 1968 a clinically practical form of levodopa therapy (Cotzias, 1968), which temporarily suspended the apparent need for movement disorders surgery.
Lesional stereotactic surgery for PD re-emerged in the 1990s for patients experiencing complications of levodopa therapy. Stereotactic targets included the: ventrolateral thalamus, globus pallidus internus (GPi), and subthalamic nucleus (STN) (Starr et al. 1998). Early in the development of stereotactic lesional surgery, neurostimulation was observed to reduce parkinsonian tremor (Hassler et al., 1960). These observations led to the development of implantable electrical stimulation devices as an alternative to stereotactic lesional surgery for Parkinson's disease.
The first permanent implant subthalamic nucleus stimulator to treat all cardinal signs of Parkinson's disease was performed by Dr. Alim Benabid in Grenoble, France in 1993 (Limousin et al., 1995). Today, deep brain stimulation (DBS) has become the "gold standard" for the surgical treatment of PD. Unlike ablation, DBS is relatively safe, non-destructive, reversible, and adjustable.