Functional Stereotactic Neurosurgery for Movement Disorders: Deep Brain Stimulation
Before chronic deep brain stimulation (DBS) became the treatment of choice in movement disorders surgery, lesioning procedures like thalamotomy and pallidotomy were used widely to treat patients with Parkinson’s disease (PD), tremor or dystonia. Compared
- PDF / 1,229,175 Bytes
- 10 Pages / 547.087 x 737.008 pts Page_size
- 41 Downloads / 220 Views
8.3 Functional Stereotactic Neurosurgery for Movement Disorders: Deep Brain Stimulation Hans-Holger Capelle and Joachim K. Krauss
8.3.1 Introduction Before chronic deep brain stimulation (DBS) became the treatment of choice in movement disorders surgery, lesioning procedures like thalamotomy and pallidotomy were used widely to treat patients with Parkinson’s disease (PD), tremor or dystonia. Compared to ablative surgery, DBS offers a non-lesional modulation of basal ganglia output; its effects are principally reversible, and it is possible to adapt the therapy to the course of the disease and the individual needs of the patient [16, 14]. The main advantage, however, is that bilateral surgery can be performed in the same operative session without increased risk for side effects (Table 8.3.1). The renaissance of movement disorders surgery for PD also renewed interest in functional stereotactic surgery for other movement disorders like dystonia [16]. In large prospective randomized studies, DBS has been shown to provide substantial benefit in PD, but also in essential tremor (ET) and generalized dystonia [2, 13, 7, 21, 8, 17, 20, 22]. The mechanisms of DBS are a matter of intensive research, and they are still not fully understood. Based on the observations drawn from microelectrode recordings and the recording of local field potentials from the basal ganglia, DBS seems to inactivate the pathological firing and interfere with oscillations of basal ganglia loops [6]. In the future, DBS may be used in combination with other new therapies and technologies. Promising therapies such as viral vectors, gene therapies, stem cell therapies and the instillation of neurotrophic factors which may aid in the survival of neurons have been or will be explored [24, 18, 19, 10].
Nowadays, DBS has been established as a powerful neurosurgical procedure for the treatment of various movement disorders. Beside the main indications for DBS, improvement has also been shown for rare disorders like hemichorea/hemiballism, Meige’s syndrome and pantothenate kinase-associated neurodegeneration (PKAN) [16]. This section gives a brief overview on the principles of DBS surgery and the main indications and clinical results of DBS for movement disorders.
8.3.2 Principles of DBS Surgery for Movement Disorders 8.3.2.1
Anatomy and Targets
The common contemporary targets for PD, ET and dystonia are shown and summarized in Fig. 8.3.1 and Table 8.3.2. Other targets of interest include the pedunculopontine nucleus and the intralaminar thalamus. The most beneficial target for treatment of ET is the nucleus ventrointermedius thalami (Vim), based on the nomenclature of Hassler, or, anatomically, the nucleus ventrolateralis posterior (VLp), based on the revised nomenclature of Jones [14]. The dorsolateral part of the subthalamic nucleus (STN) and the posteroventral lateral part of the internal pallidum (GPi) are the common anatomic targets in DBS for treatment of PD. The posteroventral lateral part of the GPi has been established also as the target of choice
Data Loading...
