ABSTRACT
Neurosurgical treatment of parkinsonism has been attempted for over a century. The first era (1890-1940) was stimulated by the lack of useful medical therapy but suffered from high rates of morbidity and mortality. The second era (1940-1970) was enhanced by the development of stereotactical neurosurgical techniques, which enabled the neurosurgeon to reach basal ganglia targets without the morbidity of a direct approach. This era was eclipsed by the advent of levodopa and dopamine agonist medical therapy. The third era (1990-1999) was a return to neurosurgical treatment due to the emergence of a model of basal ganglia circuitry, which gave scientific rationale to basal ganglia ablation, and by the adverse effects of long-term medical therapy. The current era of deep brain stimulation (DBS) emerged from advances in technology and allowed for bilateral intervention, which increased morbidity with ablative treatment. Advances in neurobiology are paving the way to a future era when surgical therapy will be based on restorative or cellular replacement strategies rather than on the modulation of basal ganglia circuitry. This chapter will chronicle the history, current status, and future of surgery for Parkinson’s disease (PD).
