Functional neurosurgery is the surgical treatment of certain neurological
disorders, notably movement disorders such as Parkinson disease,
essential tremor and dystonia. Stereotactic neurosurgery uses imaging
studies (MRI and/or CT) to identify discrete target location and guide the
approach to the target, typically through a very small opening in the skull called a burr hole.
Deep
Brain Stimulation
 Deep Brain Stimulation is the preferred surgical option when
symptom management, for Parkinson disease, essential tremor or
dystonia, is not achieved to the patient’s satisfaction by medication. In this procedure, a small electrode is implanted in the symptom-
specific site of the brain. The electrode is connected, by a thin
wire that runs under the skin, to a battery pack (called a
neurostimulator) implanted under the collarbone. The neuro-
stimulator sends electrical impulses along the wire to the electrode,
and can be adjusted to ensure greatest possible symptom control
for the patient.
Unlike earlier surgeries used to address the symptoms of movement
disorders, which destroyed a very small part of the brain, deep brain
stimulation has the benefit of being reversible, should better
therapies appear in the future.
(Medical professionals click image to view slide presentation.)
Deep
Brain Stimulation
Deep Brain Stimulation is the preferred surgical option when
symptom management, for Parkinson disease, essential tremor or
dystonia, is not achieved to the patient’s satisfaction by medication. In this procedure, a small electrode is implanted in the symptom-
specific site of the brain. The electrode is connected, by a thin
wire that runs under the skin, to a battery pack (called a
neurostimulator) implanted under the collarbone. The neuro-
stimulator sends electrical impulses along the wire to the electrode,
and can be adjusted to ensure greatest possible symptom control
for the patient.
Unlike earlier surgeries used to address the symptoms of movement
disorders, which destroyed a very small part of the brain, deep brain
stimulation has the benefit of being reversible, should better
therapies appear in the future.
(Medical professionals click image to view slide presentation.)
Deep
Brain Stimulation
Deep Brain Stimulation is the preferred surgical option when
symptom management, for Parkinson disease, essential tremor or
dystonia, is not achieved to the patient’s satisfaction by medication. In this procedure, a small electrode is implanted in the symptom-
specific site of the brain. The electrode is connected, by a thin
wire that runs under the skin, to a battery pack (called a
neurostimulator) implanted under the collarbone. The neuro-
stimulator sends electrical impulses along the wire to the electrode,
and can be adjusted to ensure greatest possible symptom control
for the patient.
Unlike earlier surgeries used to address the symptoms of movement
disorders, which destroyed a very small part of the brain, deep brain
stimulation has the benefit of being reversible, should better
therapies appear in the future.
(Medical professionals click image to view slide presentation.)
Deep
Brain Stimulation
Deep Brain Stimulation is the preferred surgical option when
symptom management, for Parkinson disease, essential tremor or
dystonia, is not achieved to the patient’s satisfaction by medication. In this procedure, a small electrode is implanted in the symptom-
specific site of the brain. The electrode is connected, by a thin
wire that runs under the skin, to a battery pack (called a
neurostimulator) implanted under the collarbone. The neuro-
stimulator sends electrical impulses along the wire to the electrode,
and can be adjusted to ensure greatest possible symptom control
for the patient.
Unlike earlier surgeries used to address the symptoms of movement
disorders, which destroyed a very small part of the brain, deep brain
stimulation has the benefit of being reversible, should better
therapies appear in the future.
(Medical professionals click image to view slide presentation.)
Parkinson's Disease
 Surgery becomes a treatment option for people who have
Parkinson disease when their symptoms are no longer
adequately controlled by medication. Each person experiences
different symptoms and each person tolerates both symptoms
and medication differently. For one person, advanced disease
may worsen symptoms beyond medication control, suggesting
surgical intervention. For another, quality of life or job related
issues may necessitate surgery in an earlier stage. There is no
right or wrong time to consider surgery, though there are
indications against surgery, including other serious illnesses (i.e.
some cardiac disease or pulmonary disease) or Parkinson’s
dementia.
Though thalamotomy and pallidotomy are still performed for
Parkinson disease in certain situations, deep brain stimulation
is now the surgery of choice. Whether electrodes are implanted
on one or both sides of the brain (in two separate surgeries, if on
both sides) will be determined by whether or not your symptoms
are equally severe on both sides of your body. DBS most often
provides significant improvement in symptom control and
allows welcome reduction in medication.
Essential
Tremor
 Essential tremor is a very common but complex movement
disorder. In most people, essential tremor is mild and can
be
controlled by medication. For some, however, the tremor is so
severe that it causes disability or significantly impacts quality of life and cannot be adequately controlled by drug therapy.
Thalamotomy, in which a portion of the thalamus
deep within
the brain is destroyed, was the neurosurgery of choice for
essential tremor until the advent of deep brain timulation and is
still used today under certain circumstances. Most often when a
thalamotomy is performed
today, however, it will be done using
stereotactic radiosurgery (see below). The essential tremor
patient electing to have deep brain stimulation surgery most
often experiences significant tremor relief.
Dystonia
Dystonia patients unable to experience symptom relief from
medication can consider deep brain stimulation as an alternate
therapy. Bilateral DBS produces substantial benefit in dystonia,
with average improvements of 50-60%.
Some primary
generalized patients have been reported to have up to 90%
improvement. DBS has also been performed on persons with
secondary dystonia, cervical dystonia, segmental dystonia and
myoclonic dystonia with encouraging results.
Top
of Page
   
Deep
Brain Stimulation
Deep Brain Stimulation is the preferred surgical option when
symptom management, for Parkinson disease, essential tremor or
dystonia, is not achieved to the patient’s satisfaction by medication. In this procedure, a small electrode is implanted in the symptom-
specific site of the brain. The electrode is connected, by a thin
wire that runs under the skin, to a battery pack (called a
neurostimulator) implanted under the collarbone. The neurostimulator sends electrical impulses along the wire to the electrode,
and can be adjusted to ensure greatest possible symptom control
for the patient.
Unlike earlier surgeries used to address the symptoms of movement
disorders, which destroyed a very small part of the brain, deep brain
stimulation has the benefit of being reversible, should better
therapies appear in the future.
Medical professionals click image to view slide presentation.
Surgery for Normal pressure hydrocephalus
 Normal
pressure hydrocephalus (NPH) is a treatable cause of
memory loss, difficulty walking, and incontinence in
elderly individuals. Treatment usually involves placement
of a ventriculoperitoneal or a lumbar-peritoneal shunt
to divert excess spinal fluid from the brain. Careful
diagnostic work-up is essential for patients suspected
of having NPH since other degenerative conditions may
mimic NPH, but do not respond to treatment with a CSF
shunt. Recent technological advances, including the
development of programmable shunt valves have made surgery
for NPH safer and have decreased the need for re-operation.
Top
of Page
Stereotactic Radiosurgery
 Stereotactic
Radiosurgery (SRS) is a minimally invasive approach
for treatment of benign and malignant brain tumors and
other neurological diseases such as vascular malformations,
pain syndromes, and movement disorders. Capabilities
for treatment of spinal tumors are presently being developed.
Radiosurgery involves computer-guided, extremely precise
delivery of high doses of radiation. By avoiding open
craniotomy in appropriate patients, radiosurgery frequently
decreases the risks associated with traditional treatment
of neurosurgical conditions. In situations where a brain
lesion cannot be safely approached by a craniotomy because
of its association with critical brain structures, radiosurgery
may represent the only treatment option. Radiosurgery
is typically an outpatient procedure and patients usually
resume normal activities immediately after treatment.
Over the past decade there have been significant advancements
in the field of stereotactic radiosurgery in conjunction
with enhanced imaging capabilities and computing power.
These technological advancements have resulted in improvement
in patient outcomes and have extended the capabilities
of radiosurgeons to safely treat a wider variety of
neurosurgical conditions. Currently the most widely
used systems for delivery of Radiosurgery are Linear
Accelerators,
Cyberknife and Gamma Knife.
Medical professionals click image to view slide show.
Top
of Page
Image Guided Craniotomy
Image-Guided
Craniotomy-Allows the surgeon to minimize the size
of required scalp incision and skull opening by enabling
real-time computer assisted intra-operative correlation
of the patient’s anatomy to the pre-operative
imaging studies such as MRI or CT. Image-guidance
also makes intracranial surgery safer and more effective
by helping the surgeon to avoid critical brain structures
during the operation while allowing him or her to
achieve a more complete removal of tumor.
Transnasal and Endonasal Transsphenoidal Surgery
 Transnasal
Transsphenoidal (TNTS) surgery is currently the preferred
method of removing a pituitary adenoma (tumor) or
cyst. It is also used for suprasellar tumors (above
the pituitary gland), retro-sellar (behind the gland)
and infra-sellar (below the gland) tumors, craniopharyngiomas,
meningiomas, chordomas and epidermoid masses.
Using this approach the surgeon enters through the
sphenoid sinus, an air space behind the nose, in order
to remove a mass. With transsphenoidal surgery there
is no external scar as the incision is made under
the lip. This approach is less invasive than a craniotomy
because it is the most direct route to the pituitary
gland. As a result the operative time is typically
shorter and patients recover more rapidly.
Endonasal (through a nostril) transsphenoidal surgery
is a more minimally invasive approach to removing
pituitary adenomas, Rathke's cleft cysts, craniopharyngiomas
and midline suprasellar meningiomas. With this approach,
there is no incision under the lip and minimal nasal
mucosal dissection as the surgeon makes an incision
in the back wall of the nose and the sphenoid sinus
is entered directly. Because there is less dissection,
a shorter and more comfortable post-operative recovery
is typical.
Both techniques may employ endoscopic assistance and
surgical navigation techniques to assist with accuracy
of tumor removal and to ensure the best chance for
preserving pituitary hormone function.
While many neurosurgeons and health care facilities exclusively employ
either a transnasal or endonasal approach, the decision on which procedure
to follow is made by Dr. Fineman based on your particular needs as determined after your MRI, physical exam and discussion with you.
Stereotactic Radiosurgery
 Stereotactic
Radiosurgery (SRS) is a minimally invasive approach
for treatment of benign and malignant brain tumors and
other neurological diseases such as vascular malformations,
pain syndromes, and movement disorders. Capabilities
for treatment of spinal tumors are presently being developed.
Radiosurgery involves computer-guided, extremely precise
delivery of high doses of radiation. By avoiding open
craniotomy in appropriate patients, radiosurgery frequently
decreases the risks associated with traditional treatment
of neurosurgical conditions. In situations where a brain
lesion cannot be safely approached by a craniotomy because
of its association with critical brain structures, radiosurgery
may represent the only treatment option. Radiosurgery
is typically an outpatient procedure and patients usually
resume normal activities immediately after treatment.
Over the past decade there have been significant advancements
in the field of stereotactic radiosurgery in conjunction
with enhanced imaging capabilities and computing power.
These technological advancements have resulted in improvement
in patient outcomes and have extended the capabilities
of radiosurgeons to safely treat a wider variety of
neurosurgical conditions. Currently the most widely
used systems for delivery of Radiosurgery are Linear
Accelerators,
Cyberknife and Gamma Knife.
Medical professionals click image to view slide show.
Top
of Page
Surgery for Tumors of the Brain and Spine
Advances in neurological
imaging modalities, computing capabilities and surgical
techniques have lead to development of different approaches
to treatment of brain tumors. The choice of a given technique
described below depends on the patient’s tumor type
and specific location within the brain. The surgeon’s
ability to choose among the various available treatment
options and tailor the treatment to a specific patient
and disease process leads to superior outcomes. A multi-disciplinary
team of physicians, including Radiation Oncologists , Medical Oncologists, and Pain
Specialists participate
in developing and tailoring each patient’s plan
of care.
Minimally-Invasive Microscopic Surgery
 Minimally-invasive
microscopic surgery allows the surgeon to minimize
the size of incision and removal of bone required
for decompression of nerves in conditions such
as disc herniation and spinal stenosis. Hospital
stays and recovery times are typically shortened
as well.
Spinal Fusion and Instrumentation
 Spinal
Fusion and Instrumentation is undertaken when
simple decompression of the nerves is inadequate
due to the presence of spinal instability (abnormal
motion). A fusion procedure links adjacent spinal
vertebrae by promoting bone growth between them.
Doing so eliminates the pain associated with abnormal
motion between the vertebrae and prevents further
injury to the nerves caused by compression and
traction on the nerves produced by the abnormal
motion.
Cervical Disc
Replacement Surgery
 Cervical Disc
Replacement Surgery is a recent advance in spinal
surgery allowing the surgeon to replace a diseased
and painful disc without performing a fusion of
the adjacent vertebrae. Doing so allows preservation
of normal motion of the spine across the replaced
disc and possibly slows the degenerative process
in the adjacent discs.
Surgery for Tumors of the Spine and Spinal Cord
 Benign
and malignant tumors can originate in the bone
of the spine, the tissues covering the spinal
cord, and the spinal cord itself. Treatment of
these tumors often requires a multidisciplinary
team of physicans, including surgeons, medical
oncologists, and radiation oncologists. Depending
on the specific disease the goal of surgery may
be removal of the tumor and/or stabilization of
the spine rendered unstable by tumor, employing
fusion and instrumentation techniques. Present
use of microscopic technique, intra-operative
nerve monitoring, and advances in spinal instrumentation
have made surgery for spinal tumors significantly
more safe
Surgery for Congenital Conditions such as Chiari Malformation
 Arnold-Chiari
Malformation is a condition in which the cerebellum
portion of the brain protrudes into the spinal
canal. It may or may not be apparent at birth.
Arnold-Chiari I type malformation usually causes
symptoms in young adults and is often associated
with syringomyelia, in which a tubular cavity
develops within the spinal cord. Arnold-Chiari
II type malformation is associated with myelomeningocele
(a defect of the spine) and hydrocephalus (increased
cerebrospinal fluid and pressure within the brain),
which usually are apparent at birth. Myelomeningocele
usually causes paralysis of the legs and, less
commonly, the arms. If left untreated, hydrocephalus
can cause mental impairment. Either type of Arnold-Chiari
Malformation can cause symptoms of headache, vomiting,
difficulty swallowing, and hoarseness.
Adults and adolescents
who are unaware they have Arnold-Chiari I type
malformation may develop headache that is predominantly
located in the back of the head and is increased
by coughing or straining. Symptoms of progressive
brain impairment may include dizziness, an impaired
ability to coordinate movement, double vision,
and involuntary, rapid, downward eye movements.
Top
of Page
| 
