Treatments We Offer

Two of the most common procedures our neurosurgeons perform are deep brain and vagus nerve stimulation. Our neurosurgeons work directly with patients to determine if these treatment options are best, or they will offer one of the many other treatment options below.

The most commonly performed functional neurosurgery procedure is deep brain stimulation (DBS), which is approved for the treatment of Parkinson's disease (PD), essential tremor (ET), torsion dystonia, and obsessive-compulsive disorder.

Deep brain stimulation is considered when medications fail to adequately control symptoms or cause intolerable side effects. Deep brain stimulation is performed in two stages:

• During the first stage, a neurosurgeon inserts an electrode into a targeted area of your brain. Mount Sinai uses both frame-based and newer frame-less techniques for placing the implants.
• During the second stage, the electrode is connected to an implantable pulse generator (IPG), which is placed beneath the skin of your chest wall, like a heart pace-maker.

The brain site to be stimulated depends on the disease to be treated. Once the incisions have healed, the devices are activated and the settings customized to meet the needs of the patient.

Patients with PD and ET often note immediate improvement, and the results are long lasting. In contrast, patients with dystonia or obsessive-compulsive disorder may not notice any benefit for weeks or months.

Over the next few years, the Food and Drug Administration (FDA) will likely approve the use of expand the use of deep brain stimulation to include medically refractory generalized and complex-partial epilepsy, major depressive disorder, eating disorders and addiction.

Cortical Stimulation is a type of neuromodulation that stimulates the surface of the brain to alter neurological disorders. Ongoing research involving cortical stimulation is being conducted to treat chronic pain, major depression and tinnitus.

Vagus Nerve Stimulation

Vagus nerve stimulation (VNS) has been widely used since the 1990s for the treatment of medically refractory epilepsy. The procedure is also performed for the treatment of severe depression that is resistant to both antidepressant medications and electroconvulsive therapy. The VNS device stimulates the brain via the left vagus nerve, which lies in the neck, so that implantation of the device does not require exposure of the brain.

Peripheral Nerve Stimulation

Peripheral nerve stimulation is a procedure that works by applying an electronic current to the peripheral nerves to relieve chronic pain. The treatment is extremely safe and has been widely used since the 1960s for chronic pain of the neck, back and for conditions such as:

• Trigeminal neuralgia
• Nerve injuries
• Occipital neuralgia/transformed migraine and other headache syndromes
• Complex regional pain syndrome
• Peripheral neuropathy

Spinal Cord Stimulation

Spinal cord stimulation uses electric currents to treat chronic back pain and other disorders that cause pain in the back. The implant is inserted during an outpatient procedure under your skin along your spinal cord and sends an electric current to block the pain signals before they reach your brain. This treatment is used for conditions such as:

• Failed back syndrome
• Complex regional pain syndrome

Intrathecal Drug Delivery

Intrathecal drug delivery is a method for delivering medication directly to the cerebrospinal fluid located in the spinal cord through an implant under the skin. The “pain pump” is programmed to deliver doses of medication throughout the day directly to the nerve thereby reducing pain. The amount of medication delivered will be determined by your doctor and can be altered throughout the therapy.

The method is designed to lessen the severity of chronic pain conditions such as:

• Failed back syndrome
• Cancer pain
• Complex regional pain syndrome

Microvascular Decompression

Microvascular decompression is a surgical procedure that is used to treat trigeminal neuralgia, glossopharyngeal neuralgia and hemifacial spasm. The goal of the procedure is to relieve the pressure on the nerve that is causing pain. The surgical procedure involves making a tiny incision in the skull behind the ear and inserting a sponge between the nerve root and blood vessel to relieve the pressure from the pulsations.

Stereotactic Radiosurgery

Stereotactic radiosurgery is a minimally invasive procedure that uses 3-D images to deliver a high dose of radiation to treat disorders such as trigeminal neuralgia.

The beam of radiation destroys the tissue that a doctor would otherwise have removed with a scalpel during an operation. In addition to treating neurological disorders, stereotactic radiosurgery is used to stop cancer growths and reduce the size of tumors and to close off abnormal blood vessels that disrupt blood flow to the brain.

Radiofrequency Lesioning Procedure

Radiofrequency lesioning is a special procedure used to block the nerve transmissions that cause chronic severe pain. Under local anesthesiaand sedation, an electrode is placed into a variety of nerve structures. The electrode transmits heat to those nerve structures and ultimately blocks the pain signals to the brain.