NEUROSURGERY DEPARTMENT HEAD Doctor Stéphan Gaillard
What is neurosurgery?
Neurosurgery is dedicated to diagnosing and operating on conditions affecting the nerves and the central nervous system. Specialists in neurosurgery are called neurosurgeons.
What pathologies does the department cover?
The department covers all conventional cranial and spinal neurosurgical conditions affecting adults.
Although certain activity sectors within the domain are especially developed:
Pituitary tumour surgery
Cerebral and lower cranium tumour surgery
Endoscopic surgery: brain, pituitary, spine
Spinal tumour and degenerative condition surgery
Minimally invasive spinal surgery (spondylolisthesis, arthrodesis….)
Functional Neurosurgery and Neuro-stimulation
What is neuro-modulation?
Neuro-modulation uses specific advances in bio-engineering technology to treat patients suffering from disorders affecting the nervous system (such as chronic pain or Parkinson's disease). In neurosurgery this involves the surgical implant of an electrical stimulation device (spinal or cerebral neuro-stimulation) or a constant programmed medication distribution device (pump implant). The device is implanted under the skin in contact with the specific part of the nervous system associated with the patient's condition. All of these techniques share the following common factors:
non-lesional: the device does not affect the integrity of the nervous system
reversible: if necessary, the implanted device can be immediately deactivated at any time
programmable: the function of the implanted device (nervous system electrical stimulation, medication distribution) is under the total control of the medical team by way of an external programming system which controls the device, ensuring that the treatment is adapted to suit the patient's specific needs:
to treat the condition, the implanted device modifies the function of a highly specific part of the nervous system
The main neurosurgical applications of neuro-modulation are the treatment of chronic pain, Parkinson's disease, medication-resistant tremors (essential tremors, tremors associated with multiple sclerosis), spasticity. Current scientific and clinical research and trials are exploring other potential applications. Hôpital Foch has authorisation for conventional intra-cranial neurosurgery and intra-cranial functional neurosurgery.
This activity requires close collaboration between various specialisations and departments: neurosurgery, the pain coordination unit, neurology, neurophysiology, neuro-radiology, physical medicine and functional rehabilitation, anaesthesiology-intensive care.
Neurosurgical treatment of pain
Treatment for pain at Hôpital Foch involves the intervention of multidisciplinary teams (the pain coordination unit, anaesthesiology-intensive care, physical medicine and functional rehabilitation, neurosurgery). In certain cases neuro-modulation implants may be envisaged to treat chronic pain which is shown to be resistant to treatment provided by the pain unit. Cases are discusses individually at multi-disciplinary meetings. The available techniques are: spinal stimulation, cortical stimulation, medication via intra-thecal pump (injection into the meninges).
Parkinson's disease requires specialised neurological care and is treated with medication. In certain cases, it can become more and more difficult to control the symptoms of the disease regardless of changes made to the medication protocols.
In this case there can be recourse to deep cerebral neuro-stimulation applied to an area of the brain called the sub-thalamic nucleus. This requires the completion of a thorough neurological survey since the conditions required for neuro-stimulation are very strict and well-defined.
Tremors (not associated with Parkinson's disease)
Tremors are a common symptom and are not always associated with Parkinson's disease. Other diseases are manifested by severe tremors such as essential tremor or multiple sclerosis (MS). In certain cases it can become increasingly difficult to control the tremors even after trying numerous medications. In this case there can be recourse to deep cerebral neuro-stimulation applied to an area of the brain called the thalamus.
For some patients who suffer injuries to the spinal cord or with multiple sclerosis (MS) the exaggeration of muscular reflexes can lead to sometimes painful muscular rigidity. Oral medication is the initial treatment for this. In more difficult cases, after a thorough medical survey, the implant of a medication delivery pump directly into the meninges can be envisaged.
Deep cerebral stimulation
Deep cerebral stimulation interventions (Parkinson's disease, tremors, others) involve implanting electrodes into a very specifically targeted area of the brain. The precision of this implant procedure requires the use of neuro-imaging and the monitoring of brain activity during the operation.
Post-operative adjustments to implanted devices
Implanted devices require regular medical monitoring through consultations or short or long-stay hospital visits to control that they function correctly and to adjust their programs as the disease and its symptoms evolve.
Changing the electrical power generator or "battery"
Electrical neuro-stimulation devices include an electrode implanted in contact with the nervous system which is connected by extension to an electrical power generator or "battery". This electrical generator has an operating life of about 4-5 years. A simple surgical operation is required to change this. In some cases, electrical power generators exist which can be charged externally thus increasing their operating life.