Current and Emerging Surgical Treatments

Challenges with Specific Mention of Contributions of Neurosurgeons (Neuromodulation)
 

Early Investigations in Neurostimulation

Electrical Stimulation was described as early as 15 AD when Scribonius used an electric torpedo fish for gout pain treatment [1]. In the 1770's both Benjamin Franklin [2] and Galvani [3] noted electrical stimulation caused muscle contraction. One hundred years later, cortical stimulation was described first in an animal [4], and in an awake patient with exposed motor cortex after debridement for osteomyelitis [5]. Intraoperative stimulation was described in 1884 by Sir Victor Horsley [6]. Spiegel and Wycis used electrical stimulation in stereotactic procedures in the 1940's, however it was Hassler who first suggested the possiblitity of long term effects of stimulation [7].

Permanent Stimulator Implants for Movement Disorders

In 1980 the term permanently implanted thalamic Deep Brain Stimulators (DBS) were reported by Cooper [8], Brice and McLellan's [9], and Benabid's groups [10]. Next DBS of the pallidum was described by Siegfried and Lippitz [11] and STN DBS was reported [12].Dystonia was treated beginning in the 1990's with pallidal stimulation in both cervical dystonia [13] and generalized dystonia [14, 15]. The Food and Drug Administration (FDA) in the United States approved thalamic DBS for Essential tremor, STN and pallidal DBS for Parkinson's Disease, and pallidal DBS for Dystonia 1997, 2002, and 2003 respectively.

Alternative Technical Approaches

New technologies in DBS placement include frameless neuronavigation [16], presurgical fabrication of an insertion platform designed to aim to the desired target, customized to the individual patients' anatomy (STarFix, FHC, Bowdoin, ME) [17], and placement of the lead using real-time high-field interventional MRI. The frameless neuronavigation and STarFix approaches allow the stereotactic imaging to be performed days before the surgery, which may improve efficiency on the day of surgery. Both require the implantation of bone-mounted fiducial markers. Pilot studies investigating the interventional MRI approach have been especially useful for patients unable to tolerate awake surgery for the DBS case [18].

References

1. Stillings, D., The first use of electricity for pain treatment M.A.o. Electro-Stimulation, Editor. 1971.
2. Isaacson, W., Benjamin Franklin. An American life. 2003 New York: Simon and Schuster.
3. 3. Pruel, M.C., A history of neuroscience from Galen to Gall, in A history of neurosurgery, D. Greenblatt S. H., T. F. , Epstein, M. H., Editor. 1997, American Association of Neurological Surgeons: Park Ridge. p. 99-130.
4. Fritsch, G. and E. Hitzig, Ueber die elektrische Erregbarkeit des Grosshims. Arch. Anat. Physiol. Wiss. Med, 1870. 37: p. 300-332.
5. Morgan, J.P., The first reported case of electrical stimulation of the human brain. J Hist Med Allied Sci, 1982. 37(1): p. 51-64.
6. Vilensky, J.A. and S. Gilman, Horsley was the first to use electrical stimulation of the human cerebral cortex intraoperatively. Surg Neurol, 2002. 58(6): p. 425-6.
7. Hassler, R., et al., Physiological observations in stereotaxic operations in extrapyramidal motor disturbances. Brain, 1960. 83: p. 337-50.
8. Cooper, I.S., A.R. Upton, and I. Amin, Reversibility of chronic neurologic deficits. Some effects of electrical stimulation of the thalamus and internal capsule in man. Appl Neurophysiol, 1980. 43(3-5): p. 244-58.
9. Brice, J. and L. McLellan, Suppression of intention tremor by contingent deep-brain stimulation. Lancet, 1980. 1(8180): p. 1221-2.
10. Benabid, A.L., et al., Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus. Lancet, 1991. 337(8738): p. 403-6.
11. Siegfried, J. and B. Lippitz, Chronic electrical stimulation of the VL-VPL complex and of the pallidum in the treatment of movement disorders: personal experience since 1982. Stereotact Funct Neurosurg, 1994. 62(1-4): p. 71-5.
12. Benabid, A.L., et al., Acute and long-term effects of subthalamic nucleus stimulation in Parkinson's disease. Stereotact Funct Neurosurg, 1994. 62(1-4): p. 76-84.
13. Krauss, J.K., et al., Bilateral stimulation of globus pallidus internus for treatment of cervical dystonia. Lancet, 1999. 354(9181): p. 837-8.
14. Coubes, P., et al., Treatment of DYT1-generalised dystonia by stimulation of the internal globus pallidus. Lancet, 2000. 355(9222): p. 2220-1.
15. Kumar, R., et al., Globus pallidus deep brain stimulation for generalized dystonia: clinical and PET investigation. Neurology, 1999. 53(4): p. 871-4.
16. Holloway, K.L., et al., Frameless stereotaxy using bone fiducial markers for deep brain stimulation. J Neurosurg, 2005. 103(3): p. 404-13.
17. Fitzpatrick, J.M., et al., Accuracy of customized miniature stereotactic platforms. Stereotact Funct Neurosurg, 2005. 83(1): p. 25-31.
18. Martin, A.J., et al., Placement of deep brain stimulator electrodes using real-time high-field interventional magnetic resonance imaging. Magn Reson Med, 2005. 54(5): p. 1107-14.