RESURGENCE OF FUNCTIONAL NEUROSURGERY FOR PARKINSONS-DISEASE - A HISTORICAL-PERSPECTIVE

The history of functional neurosurgery for the treatment of Parkinson' s disease is reviewed. Two major stages may be distinguished: (1) open functional neurosurgery, which started in 1921 with bilateral cervica l rhizotomy by Leriche, Ln 1937 Bucy performed the first motor cortect omy in a tremor patient, and subsequently introduced lesioning of the corticospinal tract at different levels. In 1939 Meyers started open t ransventricular surgery of the basal ganglia, which was abandoned in t he 1940s because of high mortality. However, this operation drew atten tion to the basal ganglia and their efferent pathways as surgical targ ets for the relief of parkinsonian symptoms. (2) Stereotactic (closed) functional neurosurgery in patients was in 1947 for the first time pe rformed by Spiegel and Wycis, soon followed by surgeons in various cou ntries. Originally, the globus pallidus and the ansa lenticularis were the surgical targets but were replaced at the end of the 1950s by the ventrolateral thalamus. A few surgeons positioned their lesions in th e subthalamic area. In both targets favorable results were reported fo r the treatment of tremor and rigidity with acceptable adverse events. In selected patients, bilateral surgery was performed. In 1969 the re sults of more than 37,000 stereotactic operations had been published. Criteria for the surgical technique and selection of patients were des cribed, and Various stereotaxic atlases became available. At that time , L-dopa be came generally available and the number of stereotactic op erations declined dramatically. However, as a result of the short-comi ngs of the L-dopa therapy in the long-term treatment of Parkinson's di sease, the thalamotomy gradually regained its place. New developments were the reintroduction of the pallidotomy by Laitinen in 1992 and the thalamic stimulation for. pharmacotherapy-resistant tremor by Benabid and collaborators in 1991. New insights in the pathophysiology of Par kinson's disease supported the revival of the functional stereotactic neurosurgery and recently caused the introduction of the subthalamic n ucleus as a surgical target in the treatment of Parkinson's disease.