Functional neurosurgery

Tremor is a common condition but can be severely disabling despite medications whereby it may limit independence in everyday tasks such as washing, writing, eating and drinking. Surgery to the thalamus of the brain can interrupt the abnormal tremor circuits. This can be done by creating a lesion such as with radiofrequency waves or by performing deep brain stimulation surgery. State-ofthe-art brain imaging and three-dimensional neurosurgical targeting are crucial to its success.

Parkinson’s disease affects people in different ways. The motor effects range from slowness and stiffness to tremor and freezing of walking. In patients with severe fluctuations in motor performance where the medications are only helping for a limited time, or are experiencing severe adverse effects from the medications such as dyskinesias/extra movements, then neurosurgery can be helpful.

Deep brain stimulation using sophisticated stereotactic neurosurgery to implant the electrodes within the deep motor brain circuits reduces symptom fluctuations, increases the duration of good motor function each day and aims to reduce medication requirements/dyskinesias. 

Dystonia can manifest in different parts of the body or even the entire body. Its effects can range from a wry neck/torticollis to severe postural deformity and pain.

Treatments include medication and botulinum injections. Deep brain stimulation surgery provides excellent relief of pain and reduction in deformity.

Hemifacial spasm produces twitches and spasms in the face. These can be intrusive and sometimes painful. If they involve the eyelid, known as blepharospasm, they can also interrupt vision. Hemifacial spasm is a form of dystonia and sometimes there are other body parts involved.

Treatments again include botulinum injections. Deep brain stimulation can be helpful for some cases of blepharospasm. MRI may demonstrate a blood vessel pulsating against the facial nerve beside the brain. This can be treated by an operation called Microvascular Decompression whereby a small hole is made at the back of the skull and the blood vessel moved away from the nerve under the operating microscope.