Functional / Restorative Neurosurgery
Dr. R Ramnarayan
M. Ch(Neurosurg), FRCS, IFAANS, Functional Fellowship (UK)
Functional/restorative neurosurgery includes :
1. Deep Brain Stimulation (DBS) For :
- Movement Disorders Like Parkinsonism, dystonias, essential tremor.
- Some psychiatric problems like depression, OCD, and some other psychiatric illnesses.
- Intractable alcoholism .
- Chronic pain especially the central post stroke pain.
- Intractable epilepsy.
- Intractable obesity.
- Some types of autism (aggressive types with self harm).
- Select cases of schizophrenia.
2. Spinal cord stimulation (SCS) is very useful in :
- Refractory angina/ Intractable heart Failure (Class 3 and 4).
- Patients with failed back surgery syndrome.
- Patients with severe painful diabetic neuropathy.
- Patients with brachial plexus injury pain.
- Patients with severe peripheral vascular disease (limb saving).
3. Vagal nerve stimulation for
- Intractable epilepsy
- Refractory depression
4. Intrathecal pumps:
- Intrathecal morphine (ITM) pumps are Very Useful in :
- Cancer pains.
- Failed back Surgery syndromes.
- Other types of noxious pain.
- Intrathecal baclofen (ITB) pumps are good in :
- All types of Spasticity as in
- Cerebral paisy
- Hypoxic encephalopathy
- Multiple Sclerosis
- Severe head injury
- Spinal Cord injury
- Stroke
- Some Neurodegenerative illness
- Patients in persistent vegetative state.
- Cases of spino-cerebellar degeneration.
- Patients with cerebellar involvement in Multiple sclerosis.
- All types of Spasticity as in
5. Sacral nerve stimulation for sphincter disturbances
- Urinary incontinence
- Urinary retention (non – Obstructive)
- Faecal incontinence
- Constipation
- Some cases of irritable bowel syndrome
- Severe pelvic pain in women





