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Intracranial Ablative Procedures

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Neurosurgical Management of Pain

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Abstract

The role of ablative neurosurgical procedures (as opposed to augmentative procedures such as stimulation or infusion) is a major issue in neurosurgical pain management. Intracranial ablative procedures have been available for over 50 years; for many conditions they have been replaced by newer augmentative procedures over the past 25 years. Some of the technological developments that facilitate augmentative and anatomic procedures, however, also facilitate ablative procedures: For example, improved stereotactic techniques, guided by computerized tomography (CT) and magnetic resonance imaging (MRI), have come into widespread use for tumor biopsy as well as functional procedures (see Figs. 15.1–15.4). Not only can these procedures be performed under local anesthesia, with or without intravenous sedation, but they require only a twist drill hole, rather than a burr hole or a craniotomy. Traditionally, ablative procedures were considered for later use in the overall management of patients; however, improved accuracy, together with the advantage of the simpler procedure for the patient, suggest a possible earlier role in patient management.

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  1. Philip L. Gildenberg
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  2. Richard B. North
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  3. Samuel J. Hassenbusch
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Editors and Affiliations

  1. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA

    Richard B. North MD

  2. Division of Neurological Surgery, Northwestern University Medical School, Chicago, IL, 60611, USA

    Robert M. Levy MD, PhD

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Gildenberg, P.L., North, R.B., Hassenbusch, S.J. (1997). Intracranial Ablative Procedures. In: North, R.B., Levy, R.M. (eds) Neurosurgical Management of Pain. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-1938-5_17

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