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Surgical Treatment of Parkinson Disease

Emad N. Eskandar, MD; G. Rees Cosgrove, MD, FRCSC; Leslie A. Shinobu, MD, PhD
JAMA. 2001;286(24):3056-3059. doi:10.1001/jama.286.24.3056.
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Several effective neurosurgical treatments for Parkinson disease (PD) have been developed based on an improved understanding of basal ganglia circuitry and the continuing evolution of neurosurgical techniques. Currently, there are 3 surgical targets for the treatment of movement disorders, the globus pallidus interna (Gpi), the subthalamic nucleus (STN), and the Ventralis intermedius nucleus of the thalamus. The Gpi and the STN are the preferred targets for the treatment of PD while Ventralis intermedius is now primarily targeted in the treatment of tremor. Options for treatment include the placement of a deep brain stimulating (DBS) electrode in any of these areas or the creation of a small lesion in the Gpi (pallidotomy) or in the thalamus (thalamotomy).

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Figure. Magnetic Resonance Images (MRIs) Showing Placement of Deep Brain Stimulating Electrodes
Graphic Jump Location
A, Axial T2-weighted MRI following a right-sided pallidotomy. The lesion (black arrowhead) is in the posterior ventral globus pallidus. B, Coronal T1-weighted MRI following placement of bilateral deep brain subthalamic stimulators (black arrowheads). The electrode has 4 1.5-mm contacts separated by 0.5 mm. The leads can be activated singly or in combination as necessary to stimulate the subthalamic nucleus while avoiding other structures.



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