Movement disorders

Abstract

Stereotactic radiosurgery (SRS) is gradually used as an alternative to open microsurgical procedures. Radiosurgery has been invented by the Swedish neurosurgeon Lars Leksell, who first treated a trigeminal neuralgia sufferer in 1951. In 1967, he conceived the Gamma Knife (GK), which uses dedicated Cobalt-60 (60Co) sources, with the initial intent to treat functional disorders. The former represent approximately 10% of the overall SRS indications. Trigeminal neuralgia is (TN) the most common, accounting for roughly 90% of them. With the development of the magnetic resonance imaging techniques, targeting of the thalamus for tremor and pain has been performed in the early 80s. Movement disorders SRS indications nowadays includes: targeting of the ventro-intermediate nucleus for tremor (essential or Parkinsonian, multiple sclerosis, other), of the subthalamic nucleus for Parkinson's disease and of the globus pallidus interne in dystonia. In the present chapter, we overview the current indications of SRS for movement disorders. We describe the level of evidence for each one of them, as well as the safety and efficacy. We summarize the technical nuances and long-term results. We specifically highlight tremor, as the main indication.