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Seminars in Neurosurgery 2001; 12(2): 161-168
DOI: 10.1055/s-2001-17122
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Guidelines for Patient Selection for Ablative and Deep Brain Stimulation Surgery

Michele Tagliati1 , Ron L. Alterman2
  • 1Department of Neurology, The Hyman-Newman Institute for Neurology and Neurosurgery, Beth Israel Medical Center, New York, NY
  • 2Department of Neurosurgery, The Hyman-Newman Institute for Neurology and Neurosurgery, Beth Israel Medical Center, New York, NY
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Publication History

Publication Date:
13 September 2001 (online)

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ABSTRACT

A series of complementary technological and scientific advances have revived interest in the surgical management of movement disorders. Deep brain stimulation (DBS) is the most important of these advances because it has expanded the indications for surgical intervention, made treatment at new targets possible, and improved the functional impact of surgery. Consequently, the selection of surgical candidates is more complex and more important to the successful management of movement disorder patients than ever before. In this article we discuss our protocol for evaluating surgical candidates, stressing the importance of the multidisciplinary team approach and strict selection criteria. Critical factors include detailed clinical assessment, neurocognitive testing, and when appropriate, positron emission tomography (PET). Indications for specific interventions, both approved and ``investigational,'' are also discussed. Although stereotactic surgery for movement disorders is becoming safer and more effective, adverse neurologic sequelae can still occur. Therefore, surgery still should only be considered for patients who are functionally disabled by symptoms that are refractory to medical treatment.

KEYWORD

Stereotactic surgery - deep brain stimulation - positron emission tomography - Parkinson's disease - tremor

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