ABSTRACT
During the twentieth century many surgical procedures, were developed for the treatment of Parkinson’s disease (PD) and other movement disorders (Fig. 1). Cortical excisions, capsulotomies, caudotomies, ansotomies, pedunculotomies, pyramidotomies, and ramicectomies were performed with variable results, and most procedures were fraught with complications (1-3), especially hemiparesis. In 1952 Cooper accidentally ligated the anterior choroidal artery in a patient with postencephalitic parkinsonism with severe rigidity, tremor, and retrocollis who was scheduled for a left cerebral peduncolotomy. In the postoperative period, tremor and rigidity improved on his right side and no hemiparesis was present (3,4). These findings resulted in a surgical target shift to the pallidum and outflow tracts (4,5). Cooper did not use stereotactic techniques for his procedures as developed by Spiegel and Wycis (6). In 1953 Narabayashi and Okuma published their first case of “chemical” pallidotomy in a PD patient (7). About the same time, Guiot and Brion reported the use of electrical coagulation of the anterodorsal pallidum (8). Leksell performed anterodorsal pallidotomies with poor results until he moved his target to the posteroventral pallidal area, which is the point where the ansa lenticularis begins (9). Of the 19 patients operated on by Leksell in the posteroventral pallidum, 95% experienced improvements in tremor, rigidity, and bradykinesia for up to 5 years. About the same time, ventrolateral thalamotomies, spearheaded by Hassler and Richert, proved to be extremely effective for the suppression of tremor. During that period, thalamotomies became a well-established surgical treatment for medically refractory PD tremor. During the latter part of the 1960s, levodopa became an established form of medical therapy and the use of surgical procedures dramatically diminished. Motor complications resulting from the long-term use of levodopa soon became evident.
