Whither lesional surgery for movement disorders

Abstract

Stereotactic surgery gained relevance in neurosurgery mainly as a surgical procedure to ameliorate symptoms of Parkinson's disease (PD) and other movement disorders. However stereotactic surgery for movement disorders has experienced fluctuating fortunes with a fall in the 1970s and resurgence in the 1990s. Lesional surgery for PD and other movement disorders gained momentum after the publication of the landmark article on pallidotomy by Laitinen et al in 1992.[1] This led to renewed interest in functional stereotactic surgery particularly pallidotomy in patients with PD. The interest in pallidotomy and thalamotomy, however, has died down in recent years due to emergence of deep brain stimulation (DBS). DBS is touted as being superior to lesional surgery such as thalamotomy and pallidotomy, as it does not destroy brain tissue and therefore, adverse effects, if any, of the stimulation are reversible unlike lesional surgery where the adverse effects of destruction of the target site are likely to be permanent. However, there have been very few articles discussing all the pros and cons of lesional surgery and DBS. In recent years DBS has almost completely replaced thalamotomy and pallidotomy in most developed countries. The question being raised in this editorial is whether lesional surgery is still relevant and whether it should be promoted amongst neurologists, neurosurgeons and patients as a safe and effective surgery for selected patients with PD and other movement disorders. The author is not exploring the relative merits and drawbacks of the two procedures (lesional surgery and DBS) to arrive at a conclusion regarding the superiority of one of the procedures. The purpose of this editorial is only to evaluate the evidence on the safety, efficacy and durability of lesional surgery for movement disorders.