Subthalamotomy for Parkinson’s Disease

  1. Obeso, J. A.
  2. Alvarez, L.
  3. Macias, R.
  4. Pavon, N.
  5. Lopez, G.
  6. Rodriguez-Rojas, R.
  7. Rodriguez-Oroz, M. C.
  8. Guridi, J.
Liburua:
Textbook of Stereotactic and Functional Neurosurgery

ISBN: 9783540699590,  9783540699606

Argitalpen urtea: 2009

Orrialdeak: 1569-1576

Mota: Liburuko kapitulua

DOI: 10.1007/978-3-540-69960-6_94 GOOGLE SCHOLAR lock_openSarbide irekia editor

Laburpena

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or the globus pallidus pars interna (GPi) has become a standard treatment of motor complications in Parkinson¿s disease (PD). Compared with classic ablative surgery, DBS offers the advantage of some degree of reversibility and adaptability, avoids causing new lesions in a brain undergoing a progressive neurodegenerative process and may be less hazardous to undertake in surgical practice. Altogether, the general medical and public opinion has evolved towards favoring DBS over potentially damaging procedures. On the other hand, ablative surgery may be the only or best option on some occasions. This may occur when, for instance, a previously implanted device for DBS has to be removed due to persistent infection or some other technical problem. In addition, DBS may not be easily applied to patients living in remote regions or may be contraindicated for patients suffering from immune deficiency or personality disorders. It should be noted that the cost of DBS and its associated consumables is not affordable for many patients in countries where medical care is not guaranteed by public institutions. Finally, there is a small proportion of PD patients with severe parkinsonian features confined to one hemisphere in whom unilateral surgery may be a reasonable therapeutic option. In such cases, a unilateral lesion may have many practical advantages over DBS.

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