gms | German Medical Science

Traditionally, neurosurgery has been hindered by the concept that damage to the human adult nervous system cannot be recovered. Indeed, most of our field has been historically focused on preserving rather than restoring function. Even surgeries aimed at functional augmentation were predicated on the resection or ablation of brain tissue. In the recent two decades, these concepts have come into considerable question with the emergence of strategies based on the delivery of biological payloads such as stem cells to treat traditionally non-neurosurgical diseases, such as completed strokes, chronic traumatic brain/spinal cord injury, and neurodegenerative disorders. In addition to biological strategies, there are technological strategies that have become common place in neurosurgery, such as neuromodulation and neurostimulation approaches to treat epilepsy and movement disorders. Refinements in these technological restoration strategies are evident on the cutting edge of clinical neuroscience. These refinements relate to increased specificity of stimulation targets to subfields within neural circuits. In addition, neural engineering strategies by which neural processes are decoded and missing and aberrant signals are given back to the damaged brain to restore the disconnected circuits are now evident and moving into the clinical arena. To accomplish this, neural signals are recorded at the single neuron level and decoded. The temporal and spatial transformation of these codes is predicted with complex mathematical models and given back to the circuit distal to the damage via advanced neural prosthetics. In this way, both cognitive and motor deficits can be restored. It is clear that to optimize the utility of both biological and technological restorative neurosurgery strategies, a continuum of care approach is necessary involving a multidisciplinary clinical team, from high level acute care to long term task specific neurorehabilitation programs such as those found in the highest-level rehabilitation centers such as Rancho Los Amigos National Rehabilitation and Restoration Center in the Los Angeles Basin. This talk provides an example of an elite restorative neurosurgery department embedded in a rehabilitation hospital and considers the essential elements required for pushing the envelope of the fundamental scope of our discipline in this exciting new direction.