Neurosurgical Approaches

Peter J Madsen; Han-Chiao Isaac Chen; Shih-Shan Lang

doi:10.1016/j.pmr.2018.04.002

Neurosurgical Approaches

Phys Med Rehabil Clin N Am. 2018 Aug;29(3):553-565. doi: 10.1016/j.pmr.2018.04.002. Epub 2018 May 29.

Authors

Peter J Madsen¹, Han-Chiao Isaac Chen¹, Shih-Shan Lang²

Affiliations

¹ Department of Neurosurgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Silverstein 3rd Floor, 3400 Spruce Street, Philadelphia, PA 19104, USA.
² Department of Neurosurgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Silverstein 3rd Floor, 3400 Spruce Street, Philadelphia, PA 19104, USA; Division of Neurosurgery, Children's Hospital of Philadelphia, Wood Center, 6th Floor, 3401 Civic Center Boulevard, Philadelphia, PA 19104-399, USA. Electronic address: chens4@email.chop.edu.

PMID: 30626515
DOI: 10.1016/j.pmr.2018.04.002

Abstract

Neurosurgery has long had a role in the treatment of disorders of muscle hyperactivity. This article discusses the use of selective peripheral neurotomy for the treatment of focal and multifocal spasticity, selective dorsal rhizotomy for alleviation of more generalized spasticity most often in the setting of cerebral palsy, dorsal root entry zone lesioning for cases of severe spasticity in a nonfunctioning limb, and deep brain stimulation for the treatment of dystonia. For each procedure, relevant pathophysiology and basic surgical anatomy and technique are addressed. Additionally, relevant aspects of patient selection, efficacy data, and complications of these procedures are discussed.

Keywords: Deep brain stimulation; Dystonia; Neurosurgery; Rhizotomy; Spasticity.

Publication types

Review

MeSH terms

Humans
Muscle Spasticity / surgery*
Neurosurgical Procedures*