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:

  1. Intrathecal morphine (ITM) pumps are Very Useful in :
    • Cancer pains.
    • Failed back Surgery syndromes.
    • Other types of noxious pain.
  2. 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.

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
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