Perspective on radiosurgery versus conventional surgery for movement disorders

Movement disorders have a long history of treatment with ablative or destructive procedures dating back to 1890 when Sir Victor Horsley performed an extirpation of the motor cortex for the treatment of athetosis. There was a great decline in the number of surgical cases when carbidopa/levodopa became popularized in 1968. Over time, we have discovered that medications have their limitations resulting in the resurgence of surgery for movement disorders. There are several surgical options available including high-intensity focused ultrasound, Gamma Knife, radiofrequency ablation, and deep brain stimulation. All but deep brain stimulation result in irreversible destruction of tissue. Deep brain stimulation has been proven to be a safe, efficient, and reversible tool to help movement neurologists optimize their patients’ quality of life. Currently, it is the therapeutic treatment of choice for refractory disorders. There are essential differences between deep brain stimulation and the ablative modalities, and each has its pros and cons. It this chapter, we will try to précis each modality and compare in between. We will also review the evidence for both deep brain stimulation and radiosurgery. We hope that the readers of this chapter will be able to use it as a tool in making better treatment decisions for their patients.​