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Neurosurgeons and Pain Physicians: Effective Collaboration. Joshua M. Rosenow, MD, FAANS, FACS Director, Functional Neurosurgery Associate Professor of Neurosurgery, Neurology and Physical Medicine and Rehabilitation Northwestern Memorial Hospital. Neurosurgeons and Pain. - PowerPoint PPT Presentation
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Northwestern University Department of Neurosurgery
Neurosurgeons and Pain Physicians:
Effective CollaborationJoshua M. Rosenow, MD, FAANS, FACSDirector, Functional NeurosurgeryAssociate Professor of Neurosurgery, Neurology and Physical Medicine and RehabilitationNorthwestern Memorial Hospital
Northwestern University Department of Neurosurgery
Neurosurgeons and Pain
What do we have to offer? (besides the capacity to create business for our anesthesia colleagues!)
On basic level – all neurosurgeons are pain surgeons Spinal surgery
Unique neurosurgical Roles Paddle leads Certain peripheral procedures Craniofacial pain procedures Central ablative procedures
Northwestern University Department of Neurosurgery
Neurosurgical Neurostimulation
Deep brain stimulation
Motor cortex stimulation
Open peripheral nerve stimulation
Northwestern University Department of Neurosurgery
Ablative Procedures
Peripheral: Neurectomy Ganglionectomy Rhizotomy Sympathectomy
Spinal cord DREZ Cordotomy Myelotomy
Brain Medullary tractotomy Thalamotomy Cingulotomy Hypothalamotomy Cortical excision
Trigeminal Gangliolysis RF ablation Glyercol Balloon compression
Northwestern University Department of Neurosurgery
Neuromodulation Collaboration
Communication pre-implant is important How did the trial really go? Best region of stimulation during the trial?
• Especially important for 16-contact percutaneous lead What hardware used for trial? What hardware desired for the implant? Specific patient factors
• Social• Psychological• Physical/Medical• Insurance
The referral email is invaluable
Northwestern University Department of Neurosurgery
Paddle Leads
Northwestern University Department of Neurosurgery
Why use paddles?
Previous difficulties with perc leads
Preference of implanter
?lower current requirement
?less interference by epidural fat
Northwestern University Department of Neurosurgery
Paddle Trial - Unique Neurosurgical Role
Lumbar fusion or laminectomy precluding
percutaneous insertion
Inability to access the epidural space
percutaneously Bony anatomy
Obesity
Prior procedure in the region of the implant Tumor resection, etc.
Northwestern University Department of Neurosurgery
Guess the level!
Northwestern University Department of Neurosurgery
Communication is key
T9
T10
Northwestern University Department of Neurosurgery
Collaboration
Works both directions When I refer:
What do I think is specific diagnosis? Why am I really referring the patient?
• Therapeutic procedures• Diagnostic procedures• Medical management• Just don’t know what else to do……
What specific services am I referring for? Do I expect to get the patient back?
I always leave final discretion to the collaborating physician
Northwestern University Department of Neurosurgery
Neurosurgeons and Anesthesiologists
Consultants
Collaborators
Co-conspirators
Our skill sets both overlap and complement each other
Northwestern University Department of Neurosurgery
E-mail: [email protected]
Thank you for coming!
Phone: 312-695-0495
Northwestern University Department of Neurosurgery
