Functional Neurosurgery: Collaboration Is Essential

Tuesday, October 31, 2017

Seth Oliveria, MD, PhD

The Oregon Clinic Neurosurgery, together with The Providence Brain and Spine Institute, recently expanded their services to include stereotactic and functional neurosurgical procedures, which use ultra-precise techniques to surgically target abnormal physiologic processes in the brain. These techniques are currently used to treat movement disorders and epilepsy, and several new indications are under investigation including Alzheimer’s disease, depression, obsessive compulsive disorder, Tourette’s syndrome, schizophrenia and traumatic brain injury.

Deep Brain Stimulation (DBS)

Deep brain stimulation involves placement of electrodes within deeply localized brain targets to alleviate symptoms in patients with movement disorders such as Parkinson’s disease, essential tremor and dystonia. These procedures can be performed awake to help fine-tune placement during surgery—or asleep if the patient prefers—using state-of-the-art intraoperative imaging and navigation software. The intracranial lead (electrode) is connected to a neurostimulator that is placed under the skin in the upper chest, similar to a cardiac pacemaker. After placement, the device can be programmed to optimize stimulation to best alleviate the patient’s symptoms.

Epilepsy Surgery

The first stages of evaluation for medically refractory epilepsy are noninvasive and include brain wave recording (EEG) and brain imaging. This initial evaluation may directly indicate that a patient is a candidate for epilepsy surgery. However, further invasive testing may be necessary, including placement of electrodes on the brain surface and/or deep inside the brain to more carefully localize the patient’s seizures. Surgical options for epilepsy include craniotomy for seizure focus resection, placement of a device similar to DBS called Neuropace that can stimulate the brain to abort a seizure as it occurs, or vagus nerve stimulation. Additionally, MRI-guided laser ablation of a seizure focus is a novel minimally invasive technique that we now offer that is performed with optic fibers through a
one centimeter incision.


There are also many promising new directions for functional neurosurgery. As described above, several new brain targets for DBS are being studied. There is considerable interest in development of brain-machine interfaces to allow patients to use brain activity to bypass paralyzed limbs to control computers or robots. A new field called optogenetics is using light instead of electricity to control the brain very selectively via delivery of transgenic light-sensitive receptors to specific populations of neurons.


Functional neurosurgical procedures are very individualized because they address symptoms and brain anatomy that are unique to each patient. All of the described surgical treatments rely heavily on a collaborative multidisciplinary approach. The decision to pursue surgery must be made jointly between the patient, their neurologist and their neurosurgeon when their condition doesn’t respond to medical therapy. The preoperative process requires close interaction between neurology and neurosurgery, but also involves specialists from neuropsychology, psychiatry, and physical, occupational and speech therapy. This multidisciplinary evaluation is ultimately used to tailor the surgical plan
to best address each individual patient’s specific needs.

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