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Vascular Surgery Headline Surgical Treatments of Swedish Heart & Vascular Institute Swedish Neuroscience Institute Parkinsons Disease Retreat Program title Presenter Rocco G. Ciocca, M.D. FACS Carter S. Gerard MD Neurosurgeon

  1. Vascular Surgery Headline Surgical Treatments of Swedish Heart & Vascular Institute Swedish Neuroscience Institute Parkinson’s Disease Retreat Program title Presenter Rocco G. Ciocca, M.D. FACS Carter S. Gerard MD Neurosurgeon title Chief of Vascular Surgery Swedish Neuroscience Institute

  2. Disclosures Headline • None Swedish Neuroscience Institute Program title Presenter title

  3. • Resting Tremor – “Being even checked by the Headline adoption of voluntary motion” • Gait Swedish Neuroscience Institute – “The legs are not raised to the height which the will Program title directs” • Nonmotor Symptoms Presenter – “The sleep becomes much disturbed” title – “The bowels require stimulating medicines to function” • Bradykinesia and Rigidity – Later described by Charcot

  4. Environmental Headline and Genetic Risk Factors Swedish Neuroscience Institute Program title Presenter title

  5. • Prestereotactic Era (1890-1954) – Surgeries involving the peripheral nervous Headline system – Resection of precentral cortex – Open resection of the basal ganglia – Swedish Neuroscience Institute 1950s- Cooper pioneered ligation of the anterior choroidal artery • Early Stereotactic Era (1947-1968) Program title – 1957 Cooper performs chemopallidectomies with procaine – Post mortem revealed thalamotomy in Presenter patient with significant tremor reduction title • Latent/Levadopa Era(1968-1992) • Ablative Surgery Era (1992-1999) • Modern/DBS Era (1993-present)

  6. Headline Swedish Neuroscience Institute Program title Presenter title

  7. Deep Brain Stimulation Headline • 1950s -Deep brain stimulation first described Swedish Neuroscience Institute • 1968 – Development of levadopa Program title • 1987- Benabid and Pollock Presenter reported VIM stimulation for Parkinson’s title • 1993 - Benabid and Pollock reported successful STN N Engl J Med. 2014 Oct 9;371(15):1369-73. doi: 10.1056/NEJMp1408779. Epub 2014 Sep 8.

  8. Who Can It Help? Headline • Confirmed Diagnosis Parkinson’s Disease Swedish Neuroscience Institute Program title • Responding to L-Dopa with side effects Presenter • Absence of Dementia title • No Untreated Depression

  9. How Does it Work? Headline Swedish Neuroscience Institute Program title Presenter title N Engl J Med. 2014 Oct 9;371(15):1369-73. doi: 10.1056/NEJMp1408779. Epub 2014 Sep 8.

  10. What is the Goal? Headline Swedish Neuroscience Institute Program title Presenter title

  11. What Are The Risks Headline • Hemorrhage(<2%) • Infection(2-3%) Swedish Neuroscience Institute • Seizure(1%) Program title • Hardware malfunction(2-3%) • Stimulation side effects Presenter – Motor – Cognitive title – Depression/Anxiety – Speech – Balance

  12. Stereotactic Technique Headline Swedish Neuroscience Institute Program title Presenter title

  13. “Millimeters Matter..” Headline Swedish Neuroscience Institute Program title Presenter title Stereotact Funct Neurosurg. 2009;87(5):297-303. doi: 10.1159/000230692. Epub 2009 Jul 29.s

  14. Confirmation: Anatomic or Physiologic Headline Swedish Neuroscience Institute Program title Presenter title

  15. Asleep Techniques Headline • CT Verified – Intraoperative CT Swedish Neuroscience Institute Program title • MRI Verified – MRI prior to reversal of anesthesia Presenter title • MRI Guided – ClearPoint J Neurosurg Pediatr. 2014 Oct;14(4):400-8. doi: 10.3171/2014.6.PEDS13605. Epub 2014 Aug 1.

  16. Directional Leads Headline Swedish Neuroscience Institute Program title Presenter title

  17. Future of DBS Headline • Closed-loop stimulation • High resolution electrodes Swedish Neuroscience Institute • Miniaturization Program title Presenter title

  18. MR Guided Focus Ultrasound Headline Swedish Neuroscience Institute Program title Presenter title

  19. Headline Swedish Neuroscience Institute Program title Presenter title

  20. Convection Enhanced Delivery Headline Swedish Neuroscience Institute Program title Presenter title

  21. Headline Swedish Neuroscience Institute Program title Presenter title

  22. Headline Swedish Neuroscience Institute Program title Presenter title

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