Surgery

By the middle of the 20th century, a handful of surgical procedures had been developed for the treatment of Parkinson disease and other movement disorders (see Plate 7-10). Cortical excisions, capsulotomies, caudotomies, ansotomies, pedunculotomies, and pyramidotomies, were performed with variable results; unfortunately, most procedures were fraught with severe side effects and terrible outcomes. In 1952, while performing a planned pedunculotomy on a 39-year-old patient with postencephalitic parkinsonism, Irving Cooper, a New York neurosurgeon, accidentally ligated the anterior choroidal artery (this type of insult results in a medial globus pallidus infarction). To Cooper’s amazement, the patient survived with resolution of the incapacitating tremor and rigidity that had hampered his quality of life up to that point. This event led to an interest in the pallidum as a surgical target. It was not until advances had occurred in the understanding of the physiology of the basal ganglia in health and disease, in surgical and imaging techniques, and in intraoperative recording devices that the current era of lesioning and later neuromodulation techniques developed.

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