There has been a great resurgence of interest in surgery for Parkinson's disease in the last few years. Both the medical community as well as the lay public are excited about the possibility of a surgical cure for this at times crippling degenerative disease.

Physicians and their patients are now more aware of surgery being an option for some patients with medically intractable and severe Parkinsons' disease. This has come about as a result of several factors, not least of which is increased media exposure in glamourising high-tech surgical procedures like fetal transplantation, deep brain stimulation and pallidotomies as being "cures" for Parkinson's disease, often displayed with dramatic effect when seen on TV/ video. But away from all this media hype, some of the other contributory factors that have popularized surgery as a viable option for the treatment of Parkinsons’ disease are;

(1) a better scientific understanding and knowledge of the neural circuits in the brain involved in Parkinson's disease, allowing more precise definition of where in the brain one could surgically intervene to improve the symptoms of Parkinson's disease 

(2) improvements in (as well as more widespread availability of neurosurgical equipment and techniques for this specialized type of stereotactic surgery 

(3) recognition by neurologists of the limits of medical therapy in this degenerative disease, and 

(4) increased public expectations of a cure for this disabling disease.

There is certainly very good surgical treatment now available for the treatment of Parkinson's disease, but it must be realized that none of these are truly "cures" for the disease in the conventional sense of the word. Most of these surgeries afford good symptomatic relief, and the results can be spectacular at times and seem to be even miraculous, but they are by no means a cure for this degenerative disease. 

Parkinson's disease is by no means a homogeneous disease and patients are troubled by different types of symptoms. The surgery for Parkinson's disease is generally also tailored to the type of symptoms patients are suffering from. Hence there are quite a few different types of operations available to treat Parkinson's disease. style="mso-spacerun: yes">Most of them are done under local anesthesia and require the placement of a special metal frame on the patient's head (stereotactic frame). This stereotactic frame allows for accurate and precise 3-dimensional localization of small, deep structures within the brain which are the usual targets for Parkinson's disease surgery.A small burr hole is then placed over the front of the head (may be bilateral if bilateral surgery is required) and a very fine electrode is then inserted into the brain through this burr hole (so-called "stereotactic insertion"). Classically, the patient is actually awake during most parts of the operation as patient cooperation is required during some parts of the operation to help localize the precise point where there is good clinical effect (so-called "physiological localization"). After this optimal point is found, the surgeon will then perform some therapeutic maneuvers (eg. deep brain stimulation or radio frequency lessoning) to this precise point in the brain (see below). The whole operation usually lasts a few hours. The rate of serious complications are usually very low from these stereotactic operations and usually pertain to bleeding into the brain caused by this electrode (1-2% chance).

Some of these operations for Parkinson's disease are; 

Deep Brain Stimulation (DBS): This is the operation that is proving to be the most promising and becoming very popular worldwide. Deep brain structures such as the subthalamic nucleus (STN), Vim (ventro-intermediate) nucleus of the thalamus, and the posterior ventral part of the pallidum (PVP) are the usual targets. A fine stimulation electrode with 4 leads is accurately inserted into one of the above targets in the patient's brain using some form of imaging (CT or MRI scan) and computer guidance (so called "stereotactic" insertion). Bilateral DBS of the STN can alleviate most of the cardinal symptoms of Parkinson's disease (tremor, rigidity, bradykinesia) and is fast becoming the most popular operation for Parkinson's disease nowadays. The Vim nucleus is the traditional target for tremor and the PVP is good for dopa dyskinesia as well as some of the other symptoms of Parkinson's disease. DBS surgery is safer and more complication-free than lesioning surgery (see below) because no permanent destruction is done to the brain targets.

2) Fetal Transplantation: This had the promise to cure Parkinson's disease, but unfortunately, recent trials have shown significant side effects in a small proportion of patients such that the therapy is no longer recommended.

3) Lesioning: Radiofrequency lesioning or Gamma knife radiosurgery. This is similar to DBS surgery but instead of using a DBS, a permanent destructive lesion is made in the brain. Consequently, the chance of side effects occurring is higher compared to DBS, particularly if the accuracy in localization was slightly off.

Your doctor would be the best person to advise you on which of these operations would be the most useful if you are a suitable candidate for Parkinson's disease surgery.