Surgery for Parkinson's Disease

Parkinson's Disease (PD) is a progressive neurological disorder caused by a loss of nerve cells in the substantia nigra, a small area deep within the brainstem. In most cases, the cause of PD is unknown although Parkinson's-like conditions can be seen after stroke, encephalitis, carbon monoxide or manganese poisoning and head trauma.

The onset is usually insidious and occurs in most patients in their 50's and 60's. The major manifestations of the disease consist of resting tremor, rigidity, bradykinesia [slowness of movements] and involuntary movements. Gait disturbance is also a prominent symptom of Parkinson's Disease.

Attending neurosurgeons in functional and stereotactic neurosurgery (including electrophysiologically monitored pallidotomy for Parkinson's disease and thalamotomy for disabling tremor):

• Emad N. Eskandar, M.D.
• Ziv Williams, M.D.
  
  
• Operation Restores Mobility to Parkinson's Patient.
• Transplantation for Parkinson's Disease.
• Parkinson's Disease Support .
• Stages of Parkinson's Disease.
• Parkinson's disease links .

Neurosurgical Treatment Chronic Pain Syndromes

Surgery can dramatically benefit people suffering from certain pain syndromes, particularly those characterized by paroxysmal pain such as trigeminal and glossopharyngeal neuralgia.

Operations available for certain specific syndromes include radiofrequency lesioning, glycerol or phenol injection, the insertion of epidural catheters for continuous medication infusion, cordotomy, and stereotactic cingulotomy:

• Emad N. Eskandar, M.D.
• Ernest S. Mathews, M.D.
  
  
• Chronic pain links

Neurosurgical Treatment of Movement Disorders

Spasmodic Torticollis (ST) is a neurological disorder that affects the muscles of the neck causing the head to pull, turn or jerk toward the shoulder. It is generally a chronic condition which may last indefinitely. It can begin at any time in life, although the symptoms appear in middle age. About 3 out of every 10,000 people are affected. This means that approximately 83,000 people have ST. Although caused by a dysfunction in the brain, its symptoms are limited to sustained or intermittent involuntary contractions of the muscles around the neck which control the position of the head. This causes the head to lean or turn to one side; it may also be pulled forward or backward. Some patients also experience shaking movements of the head and arms.

Neurosurgical treatments can provide dramatic relief in selected cases of spasmodic torticollis and other focal dystonias. Neurosurgical treatment is also available for spasticity (muscle spasms, usually caused by stroke or other neurologic diseases) of the arms and legs that is refractory to medical treatments. A variety of procedures are available through the MGH neurosurgical service. For more information contact:

• Emad N. Eskandar, M.D.
• MGH Movement Disorders Unit
• MGH Neurology Web Dystonia Forum
• Links to other information on spasmodic torticollis, dystonia and spasticity

Neurosurgical Treatment for Refractory Psychiatric Diseases

Neurosurgical treatment of medically refractory psychiatric diseases such as depression and obsessive-compulsive disorder (OCD):

• Emad N. Eskandar, M.D.
• Overview of Psychiatric Neurosurgery
• MGH Psychiatric Neurosurgery Committee
• MGH Psychiatry Homepage

Information resources (Links):

• Interstitial Radiosurgery: The Photon Radiosurgical System.
• Functional MRI Imaging For Intracranial Navigation.
• Pain Links.
• Parkinson's Disease Links.
• Surgical Treatment of Epilepsy.
• Epilepsy Surgery Links.
• Movement Disorder Surgery Links
  
• Please, add (and look for) additional links in the
  Functional Neurourgery Guestbook.

Selected Publications:

• Treatment of Intractable Psychiatric Illness and Chronic Pain by Stereotactic Cingulotomy, Ballantine HT and Cosgrove GR in Operative Neurosurgical Techniques. Schmidek HH and Sweet WH (eds), WB Saunders and Co:Philadelphia, 1995.
• Motor Sequelae and Involuntary Movement Disorders, Frim DM and Cosgrove GR in Outcome After Head, Neck and Spinal Trauma: A Medico-legal Guide. MacFarlane R and Hardy D (eds), Butterworth-Heinemann, London, 1995.
• An Approach to Neurosurgical Interventions for Persistent Pain, Frim DM and Cosgrove GR in The MGH Manual for Pain. Boorsok D (ed), 1995.
• Pyschosurgery, Cosgrove GR and Rauch SL in Neurosurgical Clinics of North America. Gildenberg PH (ed), WB Saunders and Co:Philadelphia, 1995.
• Interstitial Radiosurgery, Zervas NT and Cosgrove GR in A Textbook of Stereotactic andFunctional Neurosurgery. Gildenberg PH and Tasker R (eds), McGraw-Hill, Philadelphia, 1996.
• Cingulotomy for Psychiatric Illness, Cosgrove GR and Ballantine HT in A Textbook of Stereotactic and Functional Neurosurgery. Gildenberg PH and Tasker R (eds), McGraw-Hill, Philadelphia, 1996.
• Functional Magnetic Resonance Imaging for Intracranial Navigation, Cosgrove GR, Buchbinder BR and Jiang H in Neurosurgical Clinics of North America. Maciunas R (ed), WB Saunders and Co:Philadelphia, 1996.
• The Surgical Treatment of Epilepsy, Cosgrove GR and Cole AJ in University Reports on Epilepsy. Dreifuss FE (ed), AAMC, Newtown, 1996.
• Interstitial Brachytherapy for Intracranial Metastases, McDermott MW, Cosgrove GR, Larson DA, Sneed PK, Gutin PH in Neurosurgical Clinics of North America. Harsh GR (ed), WB Saunders and Co:Philadelphia, 1996.
• Psychosurgery, Cosgrove GR and Rauch SL in Encyclopedia of Neuroscience. Adelman G and Smith B (eds), Elsevier, Amsterdam, 1997.
• Neurosurgical Treatments, Rauch SL and Cosgrove GR in Comprehensive Textbook of Psychiatry. Kaplan HI and Sadock BJ (eds), Williams and Wilkins Co: Baltimore, MD, 1997.
• Outcomes Assessment of Pallidotomy, Cosgrove GR, Shinobu L and Penney J in Clinical Neurosurgery. Grady S (eds) Williams and Wilkins Co: Baltimore, MD, 1997.
• Thalamotomy and Pallidotomy, Cosgrove GR and Eskandar E in Operative Neurosurgery. Kaye AH and Black P (eds), Churchill Livingstone: London, UK, 1997.
• Interstitial Radiosurgery: The Photoelectron Device, Cosgrove GR, Abdelaziz O and Zervas NT in Advanced Neurosurgical Navigation. Alexander E and Maciunas R (eds), Thieme: New York, NY, 1997.
• Functional MRI for Planning Cortical Resections Cosgrove GR and Buchbinder BR in Advanced Neurosurgical Navigation. Alexander E and Maciunas R (eds), Thieme: New York, NY, 1997.
• MR Guided Stereotactic Cingulotomy for Intractable Psychiatric Disease, Abdelaziz O and Cosgrove GR in Neurosurgical Operative Atlas. Rengachary SS and Wilkins RH (eds), Williams and Wilkins Co: Baltimore, MD, 1997.
• Functional MRI and PET Scanning as an Adjunct to Surgery, Cosgrove GR in Cerebral Cortical Surgery with Functional Mapping. Black P (ed), 1997.
• Psychosurgery: Current Status, Johnston KR and Cosgrove GR in Contemporary Neurosurgery. Tindall GT (ed), Williams and Wilkins Co: Baltimore, MD, 1997.
• Neurosurgical Treatment of Neuropsychiatric Disorders, Marino R, Cosgrove GR, in Psychiatric Clinics of North America. Miguel EC, Leckman JF, Rauch S (eds), WB Saunders andCo:Philadelphia, 1997.

Referrals | Stereotactic Surgery | Parkinson's Disease Intractable Epilepsy | Movement Disorder Surgery Guestbook | Selected Publications | Links