[Neurosurgical stereotactic treatment in Parkinson's disease]

For patients with Parkinson's disease who have become unresponsive to pharmacotherapy or have developed severe motor complications due to medical therapy, a number of symptomatic neurosurgical interventions are available: thalamotomy, thalamic stimulation and pallidotomy. These stereotactic operations are performed under local anaesthesia. The target is located using anatomical and physiological techniques, after which the neuro-ablative or neuromodulatory procedure is performed. The choice of the target depends on the symptoms of the patient that most impair daily functioning. In case of dominating tremor, thalamic surgery is performed. Patients who are mainly incapacitated by rigidity, hypokinesia or pharmacotherapy-induced dyskinesias are suitable candidates for pallidotomy. Contraindications are cognitive dysfunction, severe disturbance of gait and balance, advanced cerebral atrophy on CT or MRI, limited life expectancy and a poor general condition enhancing surgical risk, e.g. coagulation disorders or uncontrolled hypertension. Surgical treatment of Parkinson's disease is being carried out in clinical trials in the Netherlands in the Academic Medical Centre in Amsterdam, the Academic Hospital in Groningen and the St. Elisabeth Hospital in Tilburg.