Surgical Management of Synucleinopathies.

Synucleinopathies represent a diverse set of pathologies with significant morbidity and mortality. In this review, we highlight the surgical management of three synucleinopathies: Parkinson's disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA). After examining underlying molecular mechanisms and the medical management of these diseases, we explore the role of deep brain stimulation (DBS) in the treatment of synuclein pathophysiology. Further, we examine the utility of focused ultrasound (FUS) in the treatment of synucleinopathies such as PD, including its role in blood-brain barrier (BBB) opening for the delivery of novel drug therapeutics and gene therapy vectors. We also discuss other recent advances in the surgical management of MSA and DLB. Together, we give a diverse overview of current techniques in the neurosurgical management of these pathologies.

Introduction

Purpose Drug delivery with BBB opening

Study Objective To review and summarize current neurosurgical approaches—including deep brain stimulation, focused ultrasound (including blood–brain barrier opening for therapeutic delivery), and other recent advances—for managing Parkinson’s disease, dementia with Lewy bodies, and multiple system atrophy.

Disease model Synucleinopathies: Parkinson's disease, dementia with Lewy bodies, multiple system atrophy

Outcomes and Safety

Summary of Outcomes Deep brain stimulation and other neurosurgical approaches can ameliorate motor and cognitive symptoms in synucleinopathies, while focused ultrasound (FUS) is effective for blood–brain barrier opening to enable noninvasive delivery of drug therapeutics and gene therapy vectors in Parkinson’s disease. The review did not report specific FUS parameter sets or multiple tested parameter configurations.

Safety-related matter No safety issues or adverse effects are mentioned in the provided text. The excerpt discusses surgical techniques (DBS, FUS) and their applications but reports no adverse effects.

Brain Region

Visualization unavailable

Ultrasound Parameters

Focal Characteristics Focal depth: None; Focal length: None; Aperture size: None

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