Neurosurgery in Delhi

Functional neurosurgery is a branch of neurosurgery that involves treatment of neurological conditions and restoration of functions. It is the surgical alleviation of a wide range of chronic neurological symptom disorders associated with movement disorders and neuropathic pain syndromes.

Functional Neurological Symptom Disorder also known as conversion disorder arises due to a complex condition where a patient experiences physical neurological symptoms. However, these symptoms come with no underlying physical cause and are often associated with a psychological or emotional crisis.

Body Location-

Functional neurosurgery is performed in  brain and spinal cord

Procedure type-

Invasive Surgical Procedure

Location-

Brain and spinal cord

The major indicators that highlight the need for functional neurosurgery involve the conditions in which the patient experiences some of these indicators simultaneously:

• Deafness or hearing difficulties
• Difficulty swallowing
• Difficulty concentrating
• Memory problems
• Fatigue
• Numbness
• Loss of balance
• Impaired movement
• Lack of responsiveness
• Loss of the senses, such as smell or touch
• Pain in the muscles, skin, or joints
• Seizures
• Tingling sensations in the skin
• Tremors
• Twitches
• Vision problems
• Weakness
• Speech problems
• Paralysis

Some of the major conditions we treat under Functional Neurosurgery treatment include:

• Parkinsonsdisease
• Hemifacialspasm
• Dystonia
• Idiopathic dystonia
• Essential tremor
• Trigeminal neuralgia
• Additional movement disorder Pain
• Trigeminal neuralgia
• Spinal cord
• Glossopharyngeal
• Nerve Root Pain (Phantom Limb)
• Herpetic neuralgia
• Cancer pain
• Spasticity

A doctor will evaluate the patient for the current medical condition with the help of diagnostic tests results and will customise a treatment plan accordingly. However, the chance of a patient to undergo functional neurosurgery increases if a patient:

• Experiences more than one symptom that is outside of his conscious control and affects his movement or senses
• Is not able to know whether the physical or neurological condition they are suffering from is due to the use of any medication or some other reason
• If they suffer from symptoms due to a traumatic or stressful event

However, treatments are beneficial for those with:

• Recurrent symptoms
• Severe FND symptoms
• Other (co-occurring) psychological conditions
• Symptoms that are slow to resolve

Some of the diagnostic tests that your doctor might ask you to take for evaluation of your current medical conditionsinvolve:

• MRI
• CT scan
• Positron emission tomography (PET) or PET-CT scan
• Electroencephalography (EEG)
• Functional tests (to check for balance issues, normal reflexes, and physical movements)

In the context of functional neurosurgery, the procedure used is based on the use of electrical stimulation in order to correct the function of neural tissue – the nerve tissue. The treatment includes areas of the brain, spinal cord and peripheral nerves.

During The Procedure:- The surgeons use an implantable pulse generator, which has a thin insulated wire with four micro-electrodes attached to its tip. The team of highly experienced surgeons implant these micro-electrodes in the area of the brain, spinal cord or an occipital nerve and position it with sub-millimeter accuracy using state-of-the-art surgical navigation technology.

Functional neurosurgery is used to treat various conditions of the Central Nervous System such as epilepsy, movement disorders and trigeminal neuralgia. Technique used depends on the condition-

• Laser ablation surgery- It is a minimally invasive surgery unlike craniotomies that require removal of part of the skull.
• Vagus nerve stimulation- It is an outpatient surgery in which mild electrical energy is sent to a nerve in the neck.
• Neuropace RNS - It is brain responsive stimulation in which the electrical activity of a patient's brain is monitored to prevent seizure before it happens.
• Deep vein stimulation (DBS) is a type of functional neurosurgery that is used to manage movement disorders such as epilepsy, dystonia and  parkinson’s disease.
• Microvascular decompression- It is a surgery in which a blood vessel that impinges the trigeminal nerve is removed.
• Percutaneous rhizotomy- In this procedure a small needle is used to damage the trigeminal nerve so that the sensation of pain is not conducted to the brain.
• Stereotactic radiosurgery (SRS)-It is a technique in which radiations are passed to damage the nerve root so that pain conduction stops.

After The Procedure : After recovery, the affected area is stimulated with the help of a surgically implanted stimulator, resembling a heart pacemaker. This is implanted under the skin of the chest. It is used to deliver the small pulses of electricity to the target area. The adjustment of the stimulation parameters of the implant are done across a wide range, which helps in relieving symptoms. This implanted system helps in changing the functioning of the brain (the ultimate neural structure), the spinal cord, cranial nerves, and the peripheral nerves.

Some of the common procedures performed using Functional Neurosurgery are:

• Deep Brain Stimulation: In this technique, a doctor uses electricity to change the function of the brain.
• Spinal Cord Stimulation:In this technique, a doctor uses electricity to alter the function of the spinal cord.
• Occipital Nerve Stimulation: In this technique, a doctor uses electricity to change the functioning of the occipital nerve.

Some of the risk factors associated with Functional Neurosurgery include:

Short term adverse effects of stimulation:

• Anxiety and nausea
• Difficulty talking
• Eyelids closing
• Visual flashes
• Jerky movements
• Limb or face contractions
• Numbness or tingling in limbs or face

These risk factors are very mild and usually reversible with adjustments in stimulation or with the help of some medication.

Some of the risk factors associated with Functional Neurosurgery include:

Short term adverse effects of stimulation:

• Anxiety and nausea
• Difficulty talking
• Eyelids closing
• Visual flashes
• Jerky movements
• Limb or face contractions
• Numbness or tingling in limbs or face

These risk factors are very mild and usually reversible with adjustments in stimulation or with the help of some medication.

General adverse effects of stimulation:

• Short term confusion
• Blood clot
• Infection of the leads
• Stroke or other neurological deficit
• A weakening of the voice
• Seizures

However, if the patient experiences these symptoms for a longer duration then he must see a doctor