E-Mail karger@karger.com Review Stereotact Funct Neurosurg 2014;92:269–281 DOI: 10.1159/000364914 The Neurosurgical Treatment of Alzheimer’s Disease: A Review Adrian W. Laxton   a Scellig Stone   b Andres M. Lozano   b   a  Department of Neurosurgery, Wake Forest Baptist Medical Center, Wake Forest University, Winston Salem, N.C., USA; b  Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ont., Canada Introduction The field of neurosurgery has traditionally focused on the identification and elimination of structural patholo- gies in the brain and spine. More recently, however, neu- rosurgeons have made important contributions to the treatment of functional neurological disorders. Deep brain stimulation (DBS) has become a well-established therapeutic modality in the treatment of some movement disorders, and it may also have a role in the treatment of certain neuropsychiatric conditions [1–3]. Perhaps less well known, however, is that over the past 40 years neu- rosurgeons have also attempted to apply neurosurgical approaches to the treatment of dementia, and specifically Alzheimer’s disease (AD). In this paper, we review the published literature examining the neurosurgical treat- ment of AD in humans. Methods The primary literature search was made using Ovid OLDMEDLINE 1950–1965, Ovid MEDLINE 1966–2012, Ovid MEDLINE Corrections, Ovid MEDLINE in Process and Other Non-Indexed Citations, EMBASE (Excerpta Medica Database), and All EBM (Evidence-Based Medicine) Reviews (Cochrane Da- tabase of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects, and Cochrane Central Register of Controlled Trials). The search terms were as follows: ‘Alzheimer’ OR ‘dementia’ AND ‘surg’ AND ‘tri- Key Words Alzheimer’s disease · Deep brain stimulation · Neurosurgery · Therapy effects · Cognition Abstract Background: Alzheimer’s disease (AD) is a debilitating neu- rological illness of increasing prevalence. Because many patients are affected and current treatments have limited effectiveness, other therapeutic strategies are urgently needed. Objectives: Here we provide a review of the neuro- surgical approaches that have been attempted or are cur- rently being investigated for the treatment of AD. Methods: Computerized database searches identified all of the pub- lished studies in the English-language literature examining the surgical treatment of AD since 1950. Results: The follow- ing 5 categories of neurosurgical treatment were identified: cerebrospinal fluid shunting, intraventricular infusions, tis- sue grafting, gene therapy, and electrical neural stimulation. Conclusions: While none of the neurosurgical approaches applied to the treatment of AD have proven effective to date, recent trials involving gene therapy and electrical neural stimulation are showing promising early results. Larger trials investigating these treatments have been proposed or are currently under way. © 2014 S. Karger AG, Basel Received: January 7, 2014 Accepted after revision: May 30, 2014 Published online: September 18, 2014 Adrian W. Laxton, MD, FRCSC Department of Neurosurgery, Wake Forest Baptist Medical Center Wake Forest University, Medical Center Boulevard Winston Salem, NC 27157 (USA) E-Mail alaxton  @  wakehealth.edu © 2014 S. Karger AG, Basel 1011–6125/14/0925–0269$39.50/0 www.karger.com/sfn Downloaded by: Wake Forest University 152.11.191.82 - 9/18/2014 7:36:51 PM