[Neurosurgical methods in treatment of Parkinson disease. Current status]

There is a world-wide renaissance of neurosurgical treatments of Parkinson's disease (PD), based on substantial progress in basic sciences. A model of parallel motor circuitry has identified potential targets for lesioning by clarifying the pathophysiological role of the basal ganglia in PD. The internal globus pallidus (Gpi) is an essential player as it connects to thalamocortical projections and can be disinhibited by overactivity of the nucleus subthalamicus (Nst). Lesioning of these targets has been successful in MPTP damaged primates. There is clinical use of destructive as well as restorative and stimulative technics. Pallidotomy and thalamatomy have evolved by the use of better neuroradiological and electrophysiological targeting. The first technic is used for treatment of rigidity, hypokinesia and dyskinesias, the latter one has proven to be efficient for tremor. Dopaminergic reinnervation and increased dopaminergic output of the striatum has only been seen after transplantation of fetal cells; this method however carries immunological and ethical problems. The continuous high frequency stimulation of basal ganglia is the newest technic; it is highly adaptable to the patient's need and carries a low morbidity profile. Thalamic stimulation is used for the treatment of tremor. The stimulation of Nst and Gpi are proposed for dyskinesias and on/off phenomena. Animal research further focuses on xenotransplantation and implantation of genetically transformed cells or pluripotent precursor cells.--In summary neurosurgical procedures seem to be very promising; however longterm comparison studies are needed to define the best (combination) treatment(s) for the future.