Stereotactic radiosurgery for movement disorders

Abstract

Functional radiosurgery has advanced steadily, since Leksell first utilized the gamma knife (GK) to treat intractable cancer pain (Acta Chir Scand. 1968;134(8):585–95). Worldwide, 5 % of GK surgery procedures are performed for the treatment of functional disorders, predominantly for trigeminal neuralgia. The ablation of deep brain structures using GK surgery is not widespread because visualization of functional targets is still difficult, in spite of the increased availability of advanced neuroimaging technology. However, much experience of intraoperative neurophysiological evaluation in radiofrequency thalamotomy and deep brain stimulation of the ventralis intermedius nucleus supports the use of GK thalamotomy (Stereotact Funct Neurosurg. 2005;83(2–3):108–12). GK thalamotomy is an effective alternative to radiofrequency and stimulation techniques for patients suffering from intractable tremor, who are at high surgical risk. The effectiveness of GK pallidotomy and subthalamotomy for treatment of Parkinson’s disease needs to be further clarified. This chapter includes a review of the literature on treatment, efficacy, and potential adverse events of GK surgery for patients with movement disorders.​