Although it was once common practice to treat patients with Parkinson’s disease (PD) with surgery, the advent of levodopa over 50 years ago shifted focus to the use and development of pharmacotherapies. However, pharmacotherapies do not adequately control non-motor symptoms of PD, their effectiveness decreases over time and as the disease progresses to moderate and advanced stages, and in some cases pharmacotherapies may exacerbate symptoms. In the past two decades therefore, focus has shifted back to surgical therapeutic interventions, in particular for the treatment of advanced PD.

Accuracy is the key to neurosurgery and the combination of fine stereotactic measurements with modern computer technology allows the targeting of very specific regions in the brain. The most common form of surgery is deep brain stimulation, the implantation of electrodes for continuous stimulation of select nuclei typically in the basal ganglia. Less commonly used are thermolitic lesioning or gamma knife surgery.