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What is Functional Neurosurgery?.
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1. Functional Neurosurgery and Anesthetic Considerations Susan M Ryan, PhD, MD
Associate Clinical Professor
Department of Anesthesia, UCSF
2006 Expanding area with very active clinical research and new applicationsExpanding area with very active clinical research and new applications
2. What is Functional Neurosurgery?
Neurosurgery intended to improve
or restore function by altering underlying physiology
3. Areas of Functional Neurosurgery
Movement disorders
Seizures
Pain syndromes
Psychiatric disorders
Peripheral nerve injuries
4. Areas of Expansion
Movement disorders
Seizures
Psychiatric disorders
5. Neurosurgical Techniques Deep brain stimulation (DBS)
Selective ablation
electrodes
Implantation
viral vectors
stem cells
Cranial nerve/ peripheral electrical stimulation
DBS is outgrowth of selective ablationDBS is outgrowth of selective ablation
6. Functional Neurosurgery Began in mid-1900s
Eclipsed by effective medications
Now: Non-responders
Advanced cases Ablation studies in animals
Led to understanding of behavior and neuroanatomy
Successful lesions: parkinsons
Now defunct practice of lobotomy for psychiatric diseaseAblation studies in animals
Led to understanding of behavior and neuroanatomy
Successful lesions: parkinsons
Now defunct practice of lobotomy for psychiatric disease
7. Neurosurgical Techniques Deep brain stimulation
Best established use:
Parkinsons Disease
Vagal nerve stimulation
Best established use:
Seizure disorders Acquaint you with the surgery and anesthesia
Describe these pt populations and anesthesia issues since you may encounter these pts for other surgeriies
Describe future directions for these ns techniquesAcquaint you with the surgery and anesthesia
Describe these pt populations and anesthesia issues since you may encounter these pts for other surgeriies
Describe future directions for these ns techniques
8. DBS/VNS Studies in Progress Obesity
Fibromyalgia
Cluster headache
Tourettes Syndrome
Depression
Obsessive Compulsive Disorder
9. DBS for Parkinsons Disease
10. Clinical Features Pill-rolling tremor
Masked faces
Cog-wheel rigidity
Festinating gate
Bradykinesia
Dysfunction of initiation and control of movementDysfunction of initiation and control of movement
11. Pathologic Features Progressive neuronal death
Dopamine neurons of substantia nigra
Non- dopamine populations in CNS and PNS
Bulbar function
Sympathetic chain
Parasympathetics of the gut
Do not understand why these neurons dieDo not understand why these neurons die
12. Basal Ganglia in PD