Functional Neurosurgery

The surgical division of the Jefferson Comprehensive Epilepsy Center benefits from one of the largest referral bases and clinical volumes in the country. Procedures regularly performed for the treatment of epilepsy include:

• Implants for long-term invasive monitoring
• Stereotactic EEG
• Resective surgeries, such as lobectomies and seizure focus resection
• Disconnection surgeries, such as corpus callosotomy
• Vagal nerve stimulator (VNS) implants
• Responsive neurostimulator (RNS) implants
• Deep brain stimulation (DBS) implants
• Stereotactic laser ablation

A weekly epilepsy conference is held to discuss all potential surgical candidates. The multidisciplinary conference includes neurosurgeons, epileptologists, neuropsychologists and neuroradiologists. During this conference, and through clinical exposure, residents and fellows are learn the essential elements of seizure management, how to interpret EEGs and similar neurophysiological tests, identifying suitable surgical candidates and the perioperative management of this patient population. In the operating room, trainees are directly exposed to various surgical techniques.

Faculty members actively engage in multiple research projects, which are performed in collaboration with other epilepsy centers across the United States.

The Comprehensive Parkinson’s Disease & Movement Disorder Center has been recognized as a Center of Excellence by the Parkinson’s Foundation. Patients with movement disorders, such as Parkinson’s disease, dystonia and essential tremor, are generally treated by Deep Brain Stimulation (DBS) after medical management has failed. Specific procedures performed include:

• Subthalamic Nucleus (STN) for rigidity, tremor and slowness of movement (bradykinesia) in Parkinson's Disease
• Globus Pallidus (GPi) for dystonia or Parkinson's Disease.
• Ventral Intermedius Nucleus (VIM) for tremor in essential tremor, Parkinson’s disease or other movement disorders.

Residents and fellows benefit from clinical exposure and a monthly movement disorder conference. During this conference, held between neurosurgery and neurology, physicians discuss possible DBS candidates. This provides an ideal forum for students to gain a deeper understanding of the pathophysiology of movement disorders, recognizing important clinical findings, identifying potential DBS candidates and the perioperative management of this population. Trainees are also exposed to the principles of stereotaxy, since they are involved in the planning and execution of DBS. In the operating room, In the operating room, nuances of the procedure and the integration of microelectrode recordings are emphasized.

The Division routinely evaluates patients experiencing chronic pain that has not been adequately managed by conservative therapies. Procedures performed for chronic pain include:

• Spinal cord stimulation for patients experiencing failed back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS).
• Occipital and supraorbital nerve stimulation patients with persistent headaches originating from the occipiatal or supraorbital nerves.
• Intrathecal pain pump implantation for intractable chronic pain.
• Microvascular decompression for trigeminal neuralgia, hemifacial spasm or glossopharyngeal neuralgia.
• Rhizotomy for trigeminal neuralgia.
• Cordotomy for the reduction of severe, refractory pain associated with terminal musculoskeletal or abdominal cancer.
  

Our neurosurgeons work closely with pain specialists from anesthesiology and neurology, physiatrists, oral and maxillofacial surgeons and other spine surgeons to ensure that patients are thoroughly evaluated before a functional neurosurgical procedure is deemed necessary. Students benefit from our large volume and multidisciplinary approach, as they learn to care for these patients both in and out of the operating room. Faculty members actively engage in both clinical and basic science research projects to further our understanding of pain pathways and improve clinical outcomes.