Surgery for Movement Disorders: Complications and Complication Avoidance

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Abstract
The growing recognition of the limitation of drug therapy for Parkinson's disease and the recent advances in neuroimaging and stereotactic surgical techniques have led to a renaissance of surgery for movement disorders. Deep brain stimulation has become the key treatment of medically intractable Parkinson's disease, but lesioning procedures have also enjoyed renewed popularity. The efficacy and safety of unilateral pallidotomy and thalamotomy are well established. Deep brain stimulation offers an adaptive treatment, reducing morbidity of surgery and allowing a reversible lesion-mimicking method. Cerebral tap-related complications and infections are the most common complications of these procedures. In our and others' experience all side effects due to stimulation could be reverted by adjusting stimulation parameters or by switching the stimulator off. Unfortunately, targeting in surgery for movement disorders still remains a difficult and nonstandardized procedure. It requires intraoperative neurophysiological refinement to customize the target to the patient's anatomy. If the supposed relationship between accurate placement in the best anatomical site and positive outcome is successfully confirmed, all methods that facilitate targeting will be useful to avoid complications. The 20-year-long authors' experience in surgical treatment of movement disorders is reported, focusing on complications and complication avoidance.

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