To explore the practice landscape of lesional procedures for Movement disorders in North America

There is a growing interest in incisionless lesional procedures for Movement disorders yet little is known about their practice landscape.

Thirty eight sites participated, represented by 31 (82%) neurosurgeons, 6 (16%) neurologists and 1 psychiatrist. All patients had preoperative evaluation by neurologists at 82% and by neuropsychologists at 61% of the sites. Postoperatively, all patients were followed by neurologists at the majority of the sites for more than one year. Poor DBS candidacy was the reason for choosing a lesional procedure 75% of the times while patients preferred lesion therapy at other times. MR Guided Focused Ultrasound (MRgFUS) was the most frequently performed procedure but was only offered at a third of the sites. Radiosurgery was available at the majority of the sites yet accounted for significantly smaller number of lesional procedures. Gamma Knife (GK) was three times more widely available than Linear Accelerator Stereotactic Radiosurgery (LINAC). Radiofrequency (RF) ablation was also done by the majority of sites but was used in the fewest number of lesional procedures. Thalamotomy for ET was by far the commonest procedure, and a fourth of the sites reported having done bilateral procedures.  Two thirds of respondents expressed interest in participating in a registry for lesional procedures, and a third expressed possible interest.

This large survey representing major functional neurosurgical sites reports on the current practice landscape of lesional procedures for Movement disorders in North America. This survey can be used to inform registry design and implementation