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What is Functional Neurosurgery?

Functional neurosurgery has come to include almost all neurosurgical interventions that enhance the quality of life for patients in various disease states. These procedures are to be differentiated, however, from those that are used predominantly for diagnosis (e.g., tumor biopsies), life salvaging (e.g., shunt placement or removal of a subdural hematoma) or deficit salvaging (e.g., spinal cord decompression, fixation and fusion for a collapsed vertebral body or traumatic disk herniation).

As such, functional neurosurgery has come to include surgery for control and/or cure of seizures, movement disorders, pain and several psychiatric disorders. In many cases, the diagnoses for these disorders have been obtained, and the patients have been treated - without much success - for many years, using a variety of medication and methods. Surgery often becomes a very effective option in many of these otherwise challenging cases.

Epilepsy Surgery

We currently offer a wide range of resources for patients with seizure disorders who might consider surgery as an option for treatment.

Along with in-house video EEG monitoring to help determine the focus, or foci, of the seizures, we offer the comprehensive use of sodium-Amytal testing, MRI, functional MRI, neuropsychological testing and neuropsychiatric testing.

In addition, surgical procedures that might be recommended after a full evaluation include:

Placement of subdural strips and grids
Depth electrodes
Temporal lobectomy and other focal resections
Corpus Callosotomy
Vagus nerve stimulators
Deep brain stimulation

Many patients are ideal candidates for surgical intervention, often benefiting from a complete resolution of their seizures. While cure is not always possible, surgery is becoming a safer and more reasonable option than ever before due to technology advances. Collaboration with members of the Neurologyand Behavioral Medicine departments is key to the successful management of these complex cases.

Movement Disorder Surgery

Only recently has the ability to place small electrodes in deep brain regions been refined enough to treat movement disorders. While we still perform both pallidotomies and thalamotomies, this newer use of deep brain stimulation (DBS) can be very effective in treating both Parkinson's disease and essential tremor (ET), as well as the movement disorders associated with multiple sclerosis and some types of dystonia.

The stimulators can be fine-tuned to achieve maximal results, and, in situations where the results are not optimal, they can be turned off or removed if necessary. Lahey Clinic pioneered the first use of DBS in the subthalamic nucleus in the Boston area, and continues to offer state-of-the-art techniques to patients with these problems.

Surgery for Psychiatric Disorders

We are currently planning a study on the use of deep brain stimulation in the treatment of obsessive-compulsive disorder (OCD), severe refractory depression and possibly drug and alcohol addiction. While this work is exciting, it is also very experimental and we are proceeding with caution. To date, a few encouraging reports have shown that the use of DBS for these problems may be very effective. We have both the resources and skills available to provide this option for select patients in these studies.

Jeffrey Edward Arle, MD, PhD is our functional neurosurgery specialist, and runs our movement disorder and epilepsy surgery programs. Dr. Arle works in close collaboration with the Diana Apetauerova, MD, a movement disorder specialist; Joel Oster, MD, an epilepsy expert; other members of the Department of Neurology; and neuropsychologist Dana Penney, PhD.