LAUSR

Introduction The year 2017 marks the bicentenary of the publication of “An Essay on the Shaking Palsy” by surgeon James Parkinson and has prompted this summary of surgical treatments for Parkinson's disease (PD) over the last century. Material and Methods A survey of the medical literature through the 20th century up to 2017 was conducted. Results The French doctor Rene Leriche pioneered the first neurosurgical procedure to treat PD; he performed a surgical section of the cervical nerve roots. This was followed by various attempts at cervical spinal cord tractotomy, but the results were inconsistent. Intracranial procedures started with dentatectomy, but then the field shifted towards interruption of the pyramidal tract at various levels. Russell Meyers, then Gerard Guiot and F. Fenelon, were the first to target the basal ganglia, especially the pallidum and ansa lenticularis, with better results, but with high morbidity. In 1947, the advent of the stereotactic technique enabled safe, precise and efficient targeting of various areas of the pallidothalamic circuitry for surgical sections mainly for tremor. However, in 1970, L-dopa put a damper on all parkinsonian surgery. The renaissance of PD-related surgery started in the mid-1980s with the reintroduction of posteroventral pallidotomy by Lauri Laitinen in Sweden, which was soon followed by the introduction of deep brain stimulation (DBS) by Alim Louis Benabid in Grenoble and the rest is history. Conclusion Surgery to treat PD has gone through several phases and used many techniques, yet remains a valid alternative despite advances in PD medical treatment. Also, by an historical coincidence, it was a Frenchman who started surgery for PD, and a Frenchman who later devised the most recent and globally used technique of DBS.