Functional Neurosurgery

Colorful functional neurosurgical image

The Department of Neurological Surgery's functional neurosurgery program exposes residents to medical legacy of innovative and novel treatments for neurological disorders.

The area of functional neurosurgery is a rapidly growing subspecialty and includes a spectrum of procedures. Movement disorders, such as Parkinson disease, dystonia, and essential tremor, are treated with stereotactically placed lesions or deep brain stimulators (DBS) in the subthalamic nucleus, globus pallidus interna, and ventral thalamus. The Department of Neurological Surgery was the first in North America to use deep brain stimulation of the thalamus to treat Tourette syndrome. In addition, we are utilizing microelectrode recording and pioneering the use of intraoperative MRI to guide placement of the lesion or DBS. In fact, we are one of 25 centers in the United States offering surgical of dystonia.

In collaboration with the Department of Neurology, surgical treatment of epilepsy for adult and pediatric patients has expanded. Candidates for resection of an epileptogenic focus in the brain are evaluated with a variety of techniques and technologies, including invasive monitoring utilizing stereotactically placed electrodes and craniotomy for subdural electrode grids. Appropriate candidates undergo surgical resection using electrocorticography, motor, and speech mapping to guide resection. Vagal nerve stimulators are also placed for medically refractory epilepsy patients who do not have a focal brain abnormality. We are the only program in the country offering hippocampal transection for the treatment of epilepsy.

Other functional neurosurgery procedures performed in our department include microvascular decompression or radiofrequency or Gamma Knife trigeminal rhizotomy for tic douloureux, sympathectomy for autonomic dystrophy or hyperhidrosis, selective dorsal rhizotomy and intrathecal pump implantation for spasticity and pain, and epidural spinal cord stimulators for pain.

We have participated in an NIH-supported study involving the restitution of bladder and bowel function by electrical stimulation in patients with spinal cord injury. Combined with posterior rhizotomy, this therapy has produced excellent results in the management of neurogenic bladder control.