Functional Neurosurgery and Anesthetic Considerations

1. Functional Neurosurgery and Anesthetic Considerations Susan M Ryan, PhD, MD Associate Clinical Professor Department of Anesthesia, UCSF 2006 Expanding area with very active clinical research and new applicationsExpanding area with very active clinical research and new applications

2. What is Functional Neurosurgery? �Neurosurgery intended to improve or restore function by altering underlying physiology�

3. Areas of Functional Neurosurgery Movement disorders Seizures Pain syndromes Psychiatric disorders Peripheral nerve injuries

4. Areas of Expansion Movement disorders Seizures Psychiatric disorders

5. Neurosurgical Techniques Deep brain stimulation (DBS) Selective ablation electrodes Implantation viral vectors stem cells Cranial nerve/ peripheral electrical stimulation DBS is outgrowth of selective ablationDBS is outgrowth of selective ablation

6. Functional Neurosurgery Began in mid-1900�s Eclipsed by effective medications Now: Non-responders Advanced cases Ablation studies in animals Led to understanding of behavior and neuroanatomy Successful lesions: parkinson�s Now defunct practice of lobotomy for psychiatric diseaseAblation studies in animals Led to understanding of behavior and neuroanatomy Successful lesions: parkinson�s Now defunct practice of lobotomy for psychiatric disease

7. Neurosurgical Techniques Deep brain stimulation Best established use: Parkinson�s Disease Vagal nerve stimulation Best established use: Seizure disorders Acquaint you with the surgery and anesthesia Describe these pt populations and anesthesia issues since you may encounter these pts for other surgeriies Describe future directions for these ns techniquesAcquaint you with the surgery and anesthesia Describe these pt populations and anesthesia issues since you may encounter these pts for other surgeriies Describe future directions for these ns techniques

8. DBS/VNS Studies in Progress Obesity Fibromyalgia Cluster headache Tourette�s Syndrome Depression Obsessive Compulsive Disorder

9. DBS for Parkinson�s Disease

10. Clinical Features �Pill-rolling� tremor Masked faces �Cog-wheel� rigidity Festinating gate Bradykinesia Dysfunction of initiation and control of movementDysfunction of initiation and control of movement

11. Pathologic Features Progressive neuronal death Dopamine neurons of substantia nigra Non- dopamine populations in CNS and PNS Bulbar function Sympathetic chain Parasympathetics of the gut Do not understand why these neurons dieDo not understand why these neurons die

12. Basal Ganglia in PD