In functional neurosurgery, treated conditions include movement disorders (e.g. Parkinson’s disease and essential tremor), pain, epilepsy and psychiatric conditions.
The department of neurosurgery in Helsinki has a long history of clinical excellence in the field of functional neurosurgery. Professor Lauri Laitinen, one of the pioneers of modern movement disorder neurosurgery, started operating on Parkinson patients in Helsinki in 1963, using the Cooper’s frame. Later, he invented his own frame, which was in use for 20 years in many places in the Nordic countries.
Already by 1975, 2000 thalamotomies had been performed in Helsinki, and several hundred stereotactic operations for various functional problems, such as essential tremor, epilepsy, psychiatric disorders, pain, CP and MS. The first deep brain stimulator (DBS) for treatment of Parkinsons disease was im-planted in 1995. First spinal cord stimulators for the treatment of pain were implanted already at the end of 1970’ies. During 1980’ies and 1990’ies, both percutaneous and surgical leads were used, but during the last decade, we have preferred to use a minimally invasive microneurosurgical technique.
Nowadays, the surgical treatment of movement disorders consists mostly of implanting DBS electrodes. We perform 20-30 DBS operations every year, using a frame-based technique with the Leksell frame, coordinate measurement from merged MR-images using Brainlab Sterotaxy Software and state of the art stimulator hardware. We have also started to perform DBS for treatment refractory obses-sive-compulsive disorder (in 2009) and Cluster headache.
For neuropathic pain (nerve injury, CRPS), we implant 50-60 spinal cord stimulator (SCS) leads every year. Spinal cord stimulators can also be used to treat ischemic pain. For facial pain syndromes, we perform electrocogulations, neurosurgical microdecompressions and cortical stimulations, but not ste-reotactic radiotherapies. In addition, we perform cordotomies, myelotomies and DREZ lesions for in-tractable and chronic pain, especially in cancer patients. Severe spasticity (after spinal cord injury, MS) is treated with intrathecal baclofen pumps.
Epileptic surgery is focused almost completely on pediatric cases, and we perform both non-lesional and lesional epileptic surgery.
All disciplines in functional neurosurgery have a long tradition in Helsinki. Movement disorder patients, pain patients, epilepsy patients and psychiatric patients are evaluated and treated by a well-established multidisciplinary team with neurosurgeons, neurologists, anaesthesiologists, psychiatrists, psychologists, therapists and nurses. Since Finland is a small country, functional neurosurgery has been centralized to a few neurosurgical centers, which have a long tradition in treating these challenging patients.