Functional neurosurgery is a surgical specialty focused on treating patients who experience abnormalities in the function of their central nervous system without disruption to the physical structures in the brain and spinal cord. These patients have anatomy that appears normal, but have problems with movement, perception, and other tasks involving the central nervous system. People who work in this field complete residencies in neurosurgery and may pursue fellowships for additional training.
A number of kinds of conditions are treated with functional neurosurgery. One is epilepsy, where seizure activity in the brain causes physical and neurological symptoms like twitching and memory loss. Sometimes, it is possible to isolate and ablate the area of the brain where seizures originate, preventing the recurrence of seizures. Procedures like severing the corpus callosum, the connection between the two halves of the brain, are also an option for treating patients with epilepsy that does not respond to more conservative treatment options.
Movement disorders like Parkinson's disease are also treatable with functional neurosurgery. Sometimes, surgery to disrupt the damaged section of the brain will address the distinctive tremors associated with the condition and help the patient enjoy a more normal life. Chronic pain can be managed with the assistance of functional neurosurgery to disrupt disordered pain signals sent by confused neurons, and this surgical specialty can be involved in the management of certain kinds of psychiatric disorders as well.
In functional neurosurgery, the doctor relies on a very precise knowledge of the brain's general anatomy, assisted with detailed imaging scans of the patient's brain. This information allows the doctor to target the area of the brain desired with minimal damage to neighboring tissue. The brain is a crowded environment, and making a mistake can result in permanent neurological problems for the patient, ranging from difficulty with fine motor control to slurred speech.
There are a number of approaches to functional neurosurgery, including radiosurgery, where the patient's skull is never actually opened. Instead, radiation is beamed into the brain to hit a location targeted for ablation. The radiation damages the cells in that region of the brain, resolving the problem associated with abnormal cell function. Surgeons also use techniques like laser guidance, where a three dimensional scan of the brain is constructed and used to develop a set of coordinates that can be programmed into surgical tools so the surgeon reaches the right spot. Injured areas of the brain may not always be apparent on physical examination, and using the results of functional imaging studies to pinpoint an area of interest can result in better surgical outcomes.
