Functional Neurosurgery, Pain, and Intraoperative Neurophysiology
Functional neurosurgery deals with a wide range of neurosurgical procedures for the treatment of functional disorders of the nervous system, such as movement, gait, and cognitive disorders, epilepsy, as well as pain syndromes and psychiatric conditions.
The principle of these treatments is, whenever possible, a non-destructive modulation of nervous system functions, aimed at curing the disease, alleviating symptoms, or slowing the progression of disease-related impairments.
Patient care is provided through broad interdisciplinary collaboration with the university clinics for neurology, pediatric and adolescent medicine, radiology and radiation therapy, psychiatry and psychotherapy, as well as anesthesiology, intensive care and pain management.
Collaboration with the University Clinic for Neurology in connection with treatment concepts for movement disorders was intensified in 2019 under the leadership of Dr. med. univ. Christof Brücke. The intensive interdisciplinary cooperation takes place in the comprehensive preoperative assessment, diagnostics, and selection of patients for deep brain stimulation (DBS), in intraoperative neurophysiological testing, as well as in the perioperative adjustment of patient therapy.
Our future projects in this area include:
- Transition of target planning to a 3T MRI system, for which a new metal-free stereotactic frame system (Vantage™ Frame, Fig. 1) is also planned.
- Enhancement of the planning software to incorporate diffusion tensor imaging (DTI) datasets into MRI planning and the use of the Brainlab planning system.
- Replacement and modernization of the intraoperative microelectrode recording system.
Advances in the technology of stimulation systems, including segmented stimulation electrodes and the recording of local field potentials via the stimulation electrodes, help us tailor therapies even more closely to the individual needs of patients with movement disorders.
Currently, lesions (thalamotomies) in patients with tremor disorders, for whom deep brain stimulation (DBS) is not an option, can be performed non-invasively using the Gamma Knife. At the University Clinic for Neurosurgery of MedUni Vienna and AKH Vienna, the only device in Austria suitable for this therapy is available for patients.
In the future: MRgFUS
MRgFUS stands for magnetic resonance-guided focused ultrasound therapy. With this novel treatment method, under clinical observation of awake patients and without the use of radioactive radiation, a target region in the thalamus can be heated using focused ultrasound energy until the symptoms of the tremor disorder are alleviated.
The procedure is guided and monitored using MRI (magnetic resonance imaging), which allows the treatment area to be fully visualized and treated safely. This is a technically complex but patient-friendly procedure.
The establishment of MRgFUS in Austria—including the logistical, structural, and economic requirements for performing targeted ultrasound lesions in the brain—is being developed in collaboration with the University Clinics for Neurology as well as Radiology and Nuclear Medicine.
The University Clinics for Neurosurgery and Neurology at the Medical University of Vienna, as part of the interdisciplinary project “Pre-surgical Evaluation and Epilepsy Surgery” decided early on to use deep brain stimulation (DBS) in the treatment of therapy-resistant epilepsy. In 2011, the first patient in Austria received DBS therapy for chronic stimulation of the anterior nucleus of the thalamus. Since 2011, eight patients have undergone surgery and have been included in an ongoing study of long-term outcomes as part of a multicenter European registry (Medtronic Registry for Epilepsy – MORE).
In the treatment of therapy-resistant epilepsies for which no curative surgical procedure is possible, vagus nerve stimulation (VNS) has already been successfully applied since 1999.