Brain Surgery for Parkinson's Disease: Overview

Parkinson’s disease surgery includes surgical procedures that involve device implantation in the brain or ablation (creating a lesion in the brain) to reduce some effects of the disease. For some people, this type of surgery can help improve symptoms and reduce the dose of medication needed, which may decrease medication side effects.

You would need to prepare for your operation by having preoperative brain imaging and other tests, and you can expect to recover and experience an improvement of your symptoms within a few weeks.

This surgery does not prevent Parkinson’s disease from progressing, so you might experience worsening effects of the condition and need higher medication doses down the road. This article will cover the most common types of brain surgery for Parkinson's disease, what to expect, and recovery.

What Is Brain Surgery for Parkinson’s Disease? 

Brain surgery for Parkinson’s disease is done to balance the activity in certain areas of the brain that control physical movement. The surgery can involve placement of a stimulator device or creation of a surgical lesion (cut) in the brain.

The areas of the brain that are affected by Parkinson’s disease are very small, and they are located deep within the brain. These procedures are done with precision and often with imaging guidance so your surgeon can see the structure of your brain with real-time pictures during the surgery.

Various Surgery Techniques 

There are several types of Parkinson’s disease surgery. The right method for you may be guided by your symptoms, response to medications, side effects, presurgical testing, and preference. 

Deep brain stimulation is the most common type of brain surgery to treat Parkinson’s disease. During this surgery, an electrical signal-producing device is implanted into the brain.

Areas in which a stimulator may be placed for treatment of Parkinson’s disease include: 

• Subthalamic nucleus 
• Globus pallidus internus
• Ventral intermediate nucleus of the thalamus

These procedures involve cutting the skin of the scalp and a small area of the skull bone to access the brain. Sometimes multiple stimulator leads are implanted, such as in the globus pallidus and the ventral intermediate nucleus. 

With ablation, a lesion is created to destroy a small area of the brain to balance the movements that are affected by Parkinson’s disease. 

Ablative procedures used for treating Parkinson’s disease include:

• Thalamotomy
• Pallidotomy
• Subthalamotomy

The lesions are sometimes created with a scalpel, requiring cuts into the scalp and skull, and sometimes the lesions are created with laser or radio frequency without cutting the skin or skull.

Contraindications 

You would not be a candidate for Parkinson’s disease surgery if your symptoms are mild or controlled with medication and without severe side effects. 

Factors such as your overall health and whether you have had brain damage (such as a stroke or traumatic brain injury) could make it difficult for you to recover after surgery. 

Potential Risks 

Brain surgery for Parkinson’s disease can cause complications. 

Potential adverse effects may include:

• Bleeding in the brain 
• Brain infection 
• Abnormal movements or sensations
• Confusion 

Additionally, the procedure might not sufficiently reduce your symptoms. 

Purpose of Brain Surgery for Parkinson’s Disease 

Parkinson’s disease surgery is used to treat motor effects of Parkinson’s disease, such as tremor, but it does not help non-motor effects, such as reduced facial expression and dry skin.

Parkinson’s disease can range from mild to severe, and it can be very disabling when the disease is severe. When high doses of medication are needed to control the symptoms, the medication can cause side effects such as dyskinesia (movement problems that are different from the movement issues of Parkinson’s disease), hallucinations, or both.

You might benefit from surgery if your symptoms do not improve adequately with medication or if you experience severe medication side effects.

How to Prepare 

Before surgery is considered, you would be prescribed medication for treatment of your Parkinson's disease symptoms. If your condition worsens or severe medication side effects develop, you and your neurologist would discuss the option of surgery and be referred to a neurosurgeon. 

In preparation for the procedure, you would also have brain imaging to ensure that you don't have a lesion (such as a tumor) that could interfere with your procedure. 

Additionally, you would have preoperative tests, such as a complete blood count (CBC), electrolyte panels, and an electrocardiogram (EKG). You might also have an electroencephalogram (EEG) to evaluate your brain activity. 

You might be asked to adjust your Parkinson's treatments or other medications before your procedure. If you take a blood thinner, your doctors may tell you to stop taking it at a specified date before your surgery. 

What to Expect on the Day of Surgery 

When you go for your surgery, you will meet with a nurse and have your vital signs checked. You will have an intravenous (IV) line placed in a vein, most likely in your arm. You will meet with your anesthesiologist and your surgeon, and you will be taken to the operating room. 

Before your surgery, your head will be shaved and cleansed with a sterile solution if you are having invasive surgery. If you are having a device implanted in your brain, you will also have a generator implanted in your chest or abdomen, and this area will be cleansed as well. 

You may have general anesthesia or local anesthesia and light sedation. If you are having general anesthesia, you will be put to sleep and you will have a tube placed in your throat to help you breathe. If you are having local anesthesia and light sedation, you will receive medication to make you drowsy, but you will be able to breathe on your own. 

During your surgery, you will not feel any pain. Your doctors will monitor your vital signs throughout your procedure. Often, the surgery is done with imaging guidance, and sometimes it is done with electrical signal monitoring of the brain as well.

For some procedures, your surgeon will make a cut in the skin of your scalp and then will make a cut into your skull bone, as follows:

• If you are having an ablation, your surgeon will do this either with a scalpel or with a laser device.
• During deep brain stimulation surgery, electrodes are placed into the target area in the brain and the controller is placed into the chest or abdomen. 

After your surgery is complete, your anesthetic medication will be stopped or reversed. If you have been intubated (a tube placed in your throat to help you breathe), this will be removed, and you will be able to breathe on your own. 

Recovery 

After surgery, you will be taken to a postoperative recovery area. Your medical team will monitor your vital signs and alertness as you wake up. You will eventually be able to get up with assistance, use the toilet, and gradually drink and eat as tolerated. 

You may need to stay in the hospital for one or more nights as you begin to move and walk. If you had a device implanted, your doctors will adjust the setting to manage your symptoms. 

You might need an imaging test of your brain before you are discharged from the hospital. After your hospital stay, you might be discharged home or to a rehabilitation facility. 

Long-Term Care

After surgery and the immediate postoperative period, you will need to follow up with your doctor.  Within the first few weeks after your surgery, your medical team will check to make sure that your surgical wounds are healing. They will also check for complications such as infection or bleeding. 

Get prompt medical attention if you develop:

• A severe headache
• Fever 
• Changes in muscle strength, vision, or sensation 

You may need to continue taking medication for your Parkinson’s disease after your surgery, but it will likely be at a much lower dose than what you were taking before your surgery. Over time, your doctors may need to adjust your medication if your Parkinson’s disease continues to progress.

It’s important that you maintain regular physical therapy and/or exercises at home to maximize your safety and mobility.

Summary

Advanced Parkinson’s disease that has a substantially negative effect on quality of life can sometimes be treated with procedures that involve implantation of a surgical device or creation of a lesion in the brain. This surgery might not eliminate the need for medication, but it may reduce the amount of medication needed, which decreases side effects.

A Word From Verywell

If you are considering having surgery to treat your Parkinson’s disease, ask your doctors all the questions you have so you will be able to make an informed and confident decision. After surgery, it’s important that you begin or continue exercising so you can maintain physical strength and balance to optimize your recovery.