Surgical decision-making in movement disorders: an evidence-informed narrative review of patient selection, target selection, and contemporary surgical strategies
Narrative review reveals individualized target and procedural selection strategies in movement disorders, highlighting tailored multidisciplinary evaluation over universal algorithms.
Key Points
Synthesize clinical evidence guiding patient, target, and procedural selection, along with emerging surgical technologies, across major movement disorders including Parkinson's disease, essential tremor, and dystonia.
Conducted a narrative review across PubMed, Scopus, and Google Scholar using controlled vocabulary and free-text terms for movement disorders and functional neurosurgery modalities.
Synthesized findings from randomized controlled trials, prospective and retrospective clinical studies, systematic reviews, meta-analyses, and consensus statements without quantitative evidence grading.
In Parkinson's disease, both subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) provide substantial motor improvements, with target choice driven by dyskinesia burden, medication-reduction goals, and cognitive-psychiatric vulnerability.
For essential tremor, ventral intermediate nucleus (VIM) DBS provides established adjustable bilateral control, while magnetic resonance-guided focused ultrasound (MRgFUS) offers an incisionless lesioning alternative.
Dystonia outcomes vary by etiology and chronicity, with GPi-DBS remaining the primary modality for generalized and segmental forms, whereas emerging tools like adaptive DBS and connectomics require further validation before standard-of-care adoption.