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Emerging Trends in Neurology and Neurosurgery: Awake Craniotomy and Stereotactic Surgery

Updated on January 27, 2017

Brain Biopsy under Stereotaxy. A small part of the tumor is taken via a needle with a vacuum system. The frame around the patient's head ensures a correct axis

Brain Biopsy under Stereotaxy
Brain Biopsy under Stereotaxy | Source

Emerging Trends in Neurology and Neurosurgery

Awake craniotomy and Stereotactic neurosurgery have become the latest trend in Neurosurgery. Some of the neurologic conditions which were treated medically can be treated successfully by these methods. At the outset I would like to state here that even though I am a health care professional I have not done or witnessed any of the procedures which are discussed below. These are compilations from the websites of reputed institutions where these procedures are done.

Awake Crniotomy and Stereotactic Surgery

This hub gives an overview about

  • Surgery for Intractable Tremor

  • Surgery for Parkinson’s Disease

  • Surgery for Epilepsy

  • Psychiatric Neurosurgery

Surgery for Intractable Tremor

Tremor is an involuntary rhythmical movement of the muscles

Classification of tremor:

  • Tremors at rest-tremors when the hands are in resting position

  • Postural tremors-tremors when the hands held up

  • Intentional tremors- tremors during movement

Essential tremor is intentional tremor which is disabling and which is not due to Parkinsonism or other neurological disorders like cerebrovascular accidents, trauma or multiple sclerosis. In these disorders patients may suffer from tremors because of injury to the cerebellumor cerebellar tracts. In essential tremor even though there are no other major symptoms, the tremors can be disabling and may interfere with the patient’s activities of daily living like feeding, bathing or holding objects.



Thalamotomy or Thalamic Stimulation as treatment for Essential Tremors

  • In thalamotomy, a small lesion is placed in the thalamus in an effort to abolish the tremor.

  • In thalamic stimulation a probe is placed and stimulated with varying intensity to control the tremors.

Patients of essential tremors with significant disability are considered for surgery when it is found that their tremors are refractory to medical treatment.

The drugs usually given for patients with essential tremors are

  • propanolol

  • mysoline

  • and clonazepam.

The patients are considered for surgery after extensive evaluation by a team of experts and detailed investigation for a confirmation of diagnosis.

The procedure discussed here is done when the patient is awake and with local anesthesia as the full co-operaton of the patient is required. The author of this article has not witnessed such surgeries as they are done only in few very highly reputed neurologic centers in the world.

Surgery for Parkinson's Disease

Did you know that surgical treatment for Parkinson's Disease is possible?

See results

Surgery for Parkinson’s Disease

The neurosurgical treatment for Parkinson’s disease is based on the model of the role of basal ganglia in movement disorders.

  • Neurosurgical treatment of Parkinson’s disease include implantation of deep brain stimulators in the globus pallidus interna (Gpi), the subthalamic nucleus (STN) or the Vim nucleus of the thalamus or the creation of small lesion in Gpi (Pallidotomy) or the Vim nucleus of the thalamus (Thalamatomy).

The patient is selected for surgery after detailed evaluation by the experts.

Parkinson’ disease is caused by a loss of dopaminergic neurons in the substantia nigra which is a part of basal ganglia. Parkinson’s disease is treated medically with precursors of dopamine like levodopa and carbidopa as dopamine does not cross the blood brain barrier. Surgery for Parkinson’s disease is considered usually when the medical therapy fails. Sedating agents and general anesthesia are avoided during the surgery to ensure full cooperation of the patient during the procedure.

DBS surgery - actual procedure - Stanford

Basal Ganglia in Parkinson's Disease


Psychiatric Neurosurgery

Psychiatric Neurosurgery is controversial. It was practiced very medical professionals.

As there are newer drugs available not much of psychiatric surgery is taking place as of now.

Scientists also caution about the overenthusiastic use of Psychiatric Neurosurgery.

Epilepsy Surgery

Seizures are a very disturbing phenomenon occurring as a result of some diseases of the brain or even without that. Seizures interfere with the functional level of the patients. People with history of seizures have to take precautions about a number of things in their daily life like driving, going near the waters and fire, to avoid deprivation of sleep, to avoid stimulants like alcohol etc. Anyone suffering from seizures would hope for a much more free life by putting an end to their sufferings.

It is observed that 20-30% of patients with intractable seizures are estimated to be because of some lesions in the brain. These lesions can be identified with the help of an MRI scan. There can also be an epileptogenic focus surrounding the lesion.

So the surgery for epilepsy may either be a removal of the structural lesion or it may be the removal of the structural lesion and the epileptogenic focus.


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    • thumbi7 profile imageAUTHOR

      JR Krishna 

      6 years ago from India

      HI DDE

      Thanks for the visit

    • DDE profile image

      Devika Primić 

      6 years ago from Dubrovnik, Croatia

      Well researched and helpful with a detailed diagram.

    • thumbi7 profile imageAUTHOR

      JR Krishna 

      6 years ago from India

      Hi Vinaya Ghimire

      I am glad that you enjoyed the hub

      Thanks for the visit

    • Vinaya Ghimire profile image

      Vinaya Ghimire 

      6 years ago from Nepal

      When I was in biology class, during my high school years, nervous system was my favorite subject. I gave up science for arts, but I still take interesting in scientific researches. Thanks for this well researched article.


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