SOCIETE-DE-NEUROCHIRURGIE-DE-LANGUE-FRANC AISE, 47TH ANNUAL-MEETING, MARRAKECH, 25-28 1997 - NEUROSURGICAL TREATMENT OF PARKINSONS-DISEASE AND OTHER MOVEMENT-DISORDERS

The present work is intended by its two principal authors as an exposi tion of the role of neurosurgery in the treatment of Parkinson's disea se and, additionally, in the treatment of other movement disorders. Th e first chapter is devoted to a discussion of the long history of func tional neurosurgery for movement disorders, which remains a source of valuable insights today. The field grew remarkably rapidly in the year s following the introduction of stereotaxy in 1947, and, after a slowe r period, received an important new impulse within the past decade. Mo st of the procedures discussed were developed empirically, in that the scientific explanations of their success (or failure) have usually ar rived a posteriori. Nonetheless, our present knowledge of the underlyi ng physiologic and biochemical mechanisms is considerable. Drs. Parent and Cicchetti have, therefore, assumed the task of reviewing this kno wledge with reference to the most recently published data. Jean Paul F rancke and collaborators provide an up-to-date review of the anatomy o f the thalamus and basal ganglia which deserves the attention of all n eurosurgeons, as des the review of functional imaging by Olivier Rasco l and collaborators, which explains the importance of these new techni ques for the measurement and visual display of physiologic data. Final ly, Alain Destee takes us back to the clinic and reminds us once again of the role of the neurologist in providing conservative (i.e., non-s urgical) treatment for Parkinson's disease. The emphasis on basic neur oscience in the first few chapters is perhaps unexpected in a neurosur gical text. We have included this non-clinical material to show that t he approach to Parkinson's disease involves specialists in many discip lines, and that an understanding of underlying mechanisms is indispens able. This book is intended, not only for neurosurgeons, but for all p hysicians who treat patients with Parkinson's disease. We have prepare d an English translation, published simultaneously with the French ori ginal, to help it reach the widest possible audience. The two principa l authors believe that neurosurgery has a role in the treatment of Par kinson's disease to the extent that it is simple? safe, effective, and non-traumatic to the patient. Ablative and non-destructive methods ar e reviewed. The procedures should thus be performed under local anesth esia, and should be as short as possible, to cause the patient minimal discomfort. In their view, intraoperative stereotactic ventriculograp hy obviates the need to transfer the patient to and from the magnetic resonance suite with the frame attached, and thereby shortens the proc edure, without impairing the surgical result; this aspect has been dis cussed at further length in the chapter entitled ''Stereotactic Method s''. For similar reasons, microor macrocellular recording are not perf ormed. In this work, the two principal authors have described anew the uses of a number of neurosurgical procedures once thought absolete. T hey have oriented themselve resolutely toward a simple and pragmatic a pproach centered entirely on the patient, with the single purpose of i mproving his quality of life. Their conclusions will undoubtely arouse criticism, which can only be beneficial. Nonetheless, the experience has convinced the authors that they have made the correct choices. The y hope this work will help popularize these techniques so that the gre atest possible number of patients can be helped. This is not an exhaus tive study. A greater stress on possible future therapies could have b een placed; instead, they have merely skimmed over them. It is always presumptuous to predict the future, even for visionaries. This report is meant to summarize the state of the art, as of 1996, in the neurosu rgical treatment of Parkinson's disease and other movement disorders. The authors expect the ingenuity of our peers to yield entirely new ap proaches in the years to come. The ultimate treatment will be, not neu rosurgical, but preventive, and will be given before manifestations of disease ever appear. The constant progress of medical science allows us to think this hope is not utopian.