Functional neurosurgery
- Involves the use of electrical stimulation, ablative therapy, or therapeutic infusions to mask or relieve symptoms of aberrant neurophysiology
- Advantages and disadvantages of each procedure
- Radiofrequency ablation
- Advantages:
- Quick / cheap / effective
- No shaving needed
- Disadvantages:
- Incision and burrhole needed
- One or two nights in hospital
- Deep Brain Stimulation (DBS)
- Advantages:
- Early reversibility / bilateral surgery
- No shaving needed
- Disadvantages:
- Incision and burrhole needed
- Expensive / more follow up visits
- Hardware risks: infection / breakage
- Gamma knife ablation
- Advantages:
- Incisionless day case surgery
- No shaving needed
- Blood thinners can continue
- Disadvantages:
- Delayed effect
- No clinical feedback
- Less control over lesion size
- Focused Ultrasound (FUS) ablation
- Advantages:
- Incisionless day case surgery
- Quick and effective
- Realtime temp & tremor control
- (Blood thinners can continue)
- Disadvantages:
- Head shave
- Treatment of
- Movement disorders
- Neurovascular compression syndromes
- Autonomic dysfunction
- Psychiatric disease
- Pain
- Epilepsy
Stereotactic surgery
- Indication
- Biopsy
- Deeply located cerebral lesions: especially near eloquent brain
- Brainstem lesions: may be approached through the cerebral hemisphere
- Multiple small lesions (p.350) (e.g. in some AIDS patients)
- Patient medically unable to tolerate general anesthesia for open biopsy
- Catheter placement
- Drainage of deep lesions: colloid cyst, abscess
- Indwelling catheter placement for intratumoral chemotherapy
- Radioactive implants for interstitial radiation brachytherapy
- Shunt placement: for hydrocephalus (rarely used) or to drain cyst
- Electrode placement
- Depth electrodes for epilepsy
- “Deep brain stimulation” for chronic pain (requires electrophysiologic stimulation)
- Lesion generation
- Movement disorders:
- Parkinsonism
- Dystonia,
- Hemiballismus
- Treatment of chronic pain
- Treatment of epilepsy
- Evacuation of intracerebral haemorrhage
- Using an Archimedes’ screw device
- With adjunctive urokinase or recombinant tissue-plasminogen activator
- Stereotactic “radiosurgery”
- To localize a lesion for open craniotomy (e.g. AVM, deep tumor)
- Using a ventricular-type catheter
- Using a blunt biopsy needle or introducer
- Systems using visible light laser beam for guidance
- Transoral biopsy of C2 (axis) vertebral body lesions
- “Experimental” or unconventional applications
- Stereotactic clipping of aneurysms
- Stereotactic laser surgery
- CNS transplantation: e.g. for Parkinsonism
- Foreign body removal
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