Frequently Asked Questions
What is functional neurosurgery?
Functional neurosurgery is a specialty within neurosurgery that focuses on diseases and conditions that often do not correlate to any anatomical issue that can be identified through imaging studies. Rather, these disease processes occur as a result of an inherent neurochemical or electrophysiologic defect. Examples include movement disorders – such as Parkinson’s disease, tremor and dystonia – as well as epilepsy, spasticity and chronic pain.
While most surgeons operate to correct or remove anatomical abnormalities, functional neurosurgeons strive to modulate the chemical and electrical activity in the brain or spinal cord – thereby improving the patient’s symptoms.
What diseases and conditions can be treated through functional neurosurgery?
Functional neurosurgery is a relatively new and quickly advancing specialty. At present, there are three main types of treatment, each of which can address several different diseases and conditions.
The treatments available at the Functional Neurosurgery Center at Jefferson Hospital for Neuroscience include deep brain stimulation, spinal cord stimulation and epilepsy surgery. Our Center also offers access to surgical trials for innovative therapies and new indications, or uses, of existing therapies.
Why don't more people with Parkinson’s disease and other movement disorders undergo functional neurosurgery, such as deep brain stimulation (DBS)?
Because of the progressive nature of Parkinson’s disease and the inability to “see” the disorder on diagnostic scans, it can take years to be diagnosed with this condition. Following diagnosis, oral medication is one of the most common courses of action. For many patients, medications can be of help. However, newer surgical techniques – namely, deep brain stimulation – can also have a dramatic impact on individuals with Parkinson’s. Even so, primary care physicians and even some neurologists are often not familiar with the newest advancements in this area.
Could deep brain stimulation help me or someone I care about?
For patients with Parkinson’s disease, deep brain stimulation may be a viable treatment under the following circumstances:
- The patient has typical idiopathic Parkinson’s disease (in other words, the cause of the disease is unknown).
- The patient continues to respond to levodopa or other dopaminergic medications.
- The patient is disabled by medication-refractory response fluctuations, dyskinesias (involuntary, uncontrollable and often excessive movements), parkinsonian symptoms or medication-induced side effects.
Why is Jefferson Hospital for Neuroscience an excellent choice for functional neurosurgery?
Unlike other hospitals in the area, our Center offers a full complement of treatments – including deep brain stimulation, spinal cord stimulation, epilepsy surgery and access to surgical trials. We are also fully integrated and work with a large team of neurologists, each with expertise in a subspecialty of neurological science, such as movement disorders or epilepsy. We also have a team of dedicated neuropsychologists who help to screen and counsel our patients. And we collaborate closely with Thomas Jefferson University’s Parkinson’s Disease Research Unit, headed by one of the world’s leading researchers in this field.
Another reason we’re your best choice: our patient-centric approach to care. We’re highly responsive to our patients’ medical and psychological needs and work diligently to coordinate and advocate on our patients’ behalf from diagnosis through treatment and follow-up.
Why would I choose a minimally invasive procedure instead of a traditional surgery?
In many cases, minimally invasive procedures offer some significant advantages. Those advantages include less trauma during surgery and fewer complications after. With minimally invasive procedures, you typically enjoy a shorter hospital stay (or none at all), a faster recovery and less scarring. In fact, with many of these procedures, surgeons use Band-Aids® for dressings!
Why should I choose Thomas Jefferson University Hospital for my minimally invasive procedure?
Jefferson surgeons have been performing – and pioneering – minimally invasive procedures for over a decade. Today, we have many of our surgeons have extensive experience in minimally invasive diagnostic and treatment procedures covering a wide range of medical specialties. We have experts in advanced endoscopy in our Division of Gastroenterology and Hepatology. We have leading urologists who routinely use da Vinci® Surgery for prostatectomy. And our Jefferson Hospital for Neuroscience team includes surgeons who use minimally invasive techniques to treat hard-to-reach tumors of the brain and spine using stereotactic radiosurgery, cranial base surgery and endoscopic neurosurgery.
What is the difference between laparoscopic surgery and keyhole or Band-Aid® surgery?
The terms "laparoscopic surgery," "keyhole surgery" and "Band-Aid® surgery" are interchangeable. All refer to a family of minimally invasive procedures that use small incisions and some kind of laparoscope, or high-tech camera, to guide surgeons in performing the procedures through the tiny openings. These techniques can be used for a number of procedures, including common operations like removal of the gall bladder, removal of part of the colon and removal of the kidney.
How have Jefferson operating rooms been updated for minimally invasive procedures?
Jefferson has a range of surgical suites that have been outfitted with the tools and technologies needed for minimally invasive procedures. Jefferson Hospital for Neuroscience, for example, has state-of-the-art equipment for stereotactic radiosurgery. Similarly, the Jefferson Minimally Invasive Cranial Base Surgery and Endoscopic Neurosurgery Center uses the latest digital operating rooms – the first of their kind in the Delaware Valley.
What are the advantages of stereotactic radiosurgery or radiotherapy?
Whether used alone or as a complement to traditional surgery, stereotactic radiosurgery and radiotherapy offer numerous benefits.
For starters, these treatments can be performed safely and effectively on patients who wouldn't be able to withstand traditional forms of brain or spinal surgery. Stereotactic radiosurgery and radiotherapy can also treat tumors in dangerous locations, such as the optic nerve, brain stem or spinal cord. Because they're performed on an outpatient basis, these procedures offer shorter treatment time and a dramatically lower recovery period. Finally, stereotactic radiosurgery and radiotherapy eliminate the surgical risks of infection, hemorrhage and spinal fluid leakage.
Are stereotactic radiosurgery and radiotherapy painful?
All methods of stereotactic radiosurgery and radiotherapy are virtually painless and are performed on an outpatient basis.
Single, high-dose radiation via the Gamma Knife requires that patient wear a special stereotactic head frame. This lightweight frame is attached to the skull using four small screws. To relieve any pain associated with securing the head frame, the area is numbed beforehand and a sedative is administered.
Patients who receive multiple doses of radiation often find that the biggest challenge is overcoming their initial anxiety. Because they're so tense during initial treatments, they sometimes report sore necks and backs. However, once they become familiar with the daily routine of their treatment - and realize that it's truly painless - they're able to relax.
Is stereotactic radiosurgery or radiotherapy suitable for all brain and spinal tumors?
Stereotactic radiosurgery and radiotherapy are not optimal treatments for all patients. With that in mind, patients should seek an institution that offers all the alternative treatments currently available for their particular disease. And, ideally, those treatments should all be practiced by the same medical team. This eliminates treatment bias based on a narrower, "single-tool" perspective.
In addition to assessing the versatility and objectivity of a program, patients should also consider the volume of cases handled by the medical team. When physicians have a greater depth and breadth of experience, they can confidently recommend, in some cases, no treatment when they feel observation is the most appropriate management course.
What are the side effects of stereotactic radiosurgery and radiotherapy?
For the vast majority of patients, there are virtually no side effects to stereotactic radiosurgery and radiotherapy. However, as with any medical treatment, there are some possible side effects, including hearing loss and, to a lesser extent, cranial neuropathy and radiation necrosy. Jefferson Hospital for Neuroscience's rates for these side effects are among the best in the industry.
Does hair fall out as a result of this treatment?
For the vast majority of patients, their hair does not fall out. However, some patients may experience patchy hair loss.
What are the restrictions while undergoing stereotactic radiosurgery or radiotherapy?
You will find that there are very few limitations on your day-to-day life while undergoing any of Jefferson's stereotactic radiosurgery or radiotherapy treatments. You can carry on your normal activities, including working and spending time with your family. You can even be around your children and grandchildren while undergoing treatment.
For multiple treatments, how long does each session last?
Although the actual treatment time may be as little as 20 to 30 minutes, you should allow 60 minutes each day for your appointment.