Functional neurosurgery
Deep brain stimulation
Deep brain stimulation (DBS), in which various areas of the brain involved in the pathophysiology are electrically stimulated at high frequency via chronically implanted electrodes, is an established and effective therapy for movement disorders to improve motor symptoms and pharmacologically induced side effects. The procedure is also increasingly being used experimentally for neuropsychiatric disorders.
Projects in the field of functional neurosurgery include clinical studies on DBS in movement disorders (dystonia, Parkinson's disease), neuropsychiatric disorders (obsessive-compulsive disorder, Tourette's, depression) and neuropathic pain syndromes. These diseases are associated with abnormal neuronal oscillatory activity in various regions of the brain. Intraoperatively, the activity of individual nerve cells is recorded using high-resistance electrodes in order to optimally position the DBS electrodes in the target region. These recordings help to clarify the pathophysiology of neuronal activity in the various diseases. For further clarification, we derive local field potentials from the various contacts of the DBS electrodes postoperatively for selected questions, while these are externalized for clinical assessment of the stimulation success. During the recordings, various motor and cognitive tasks can be performed by the patients in order to better understand the involvement of the various brain regions in these functions.
In addition, the Clinical Department of Neurosurgery is involved in several collaborative projects (Berlin, Würzburg, Lübeck, Cologne). The STIM-TOX study should be mentioned here in particular. Another focus is the development of treatment algorithms for multifocal deep brain stimulation in rare movement disorders. In cooperation with clinical psychiatry, we are also investigating the effects of deep brain stimulation in patients with Tourette's syndrome, obsessive-compulsive disorder and Alzheimer's disease.
Further information
Runge J, Nagel JM, Schrader C, Blahak C, Weigel RE, Wolf ME, Heissler HE, Saryyeva A, Krauss JK. Microelectrode recording and hemorrhage in functional neurosurgery: a comparative analysis in a consecutive series of 645 procedures. J Neurosurg. 2023 Nov 3:1-9. DOI: 10.3171/2023.8.JNS23613
Koy A, Kühn AA, Schiller P, Huebl J, Schneider GH, Eckenweiler M, Rensing-Zimmermann C, Coenen VA, Krauss JK, Saryyeva A, Hartmann H, Lorenz D, Volkmann J, Matthies C, Schnitzler A, Vesper J, Gharabaghi A, Weiss D, Bevot A, Marks W, Howser A, Monbaliu E, Mueller J, Prinz-Langenohl R, Visser-Vandewalle V, Timmermann L; STIM-CP investigators. Long-Term Follow-Up of Pediatric Patients with Dyskinetic Cerebral Palsy and Deep Brain Stimulation. Mov Disord. 2023 Sep;38(9):1736-1742. DOI: 10.1002/mds.29516
Krauss JK, Lipsman N, Aziz T, Boutet A, Brown P, Chang JW, Davidson B, Grill WM, Hariz MI, Horn A, Schulder M, Mammis A, Tass PA, Volkmann J, Lozano AM. Technology of deep brain stimulation: current status and future directions. Nat Rev Neurol. 2021 Feb;17(2):75-87. DOI: 10.1038/s41582-020-00426-z
Müller-Vahl KR, Szejko N, Saryyeva A, Schrader C, Krueger D, Horn A, Kühn AA, Krauss JK. Randomized double-blind sham-controlled trial of thalamic versus GPi stimulation in patients with severe medically refractory Gilles de la Tourette syndrome. Brain Stimul. 2021 May-Jun;14(3):662-675. DOI: 10.1016/j.brs.2021.04.004
Abdallat M, Saryyeva A, Blahak C, Wolf ME, Weigel R, Loher TJ, Runge J, Heissler HE, Kinfe TM, Krauss JK. Centromedian-Parafascicular and Somatosensory Thalamic Deep Brain Stimulation for Treatment of Chronic Neuropathic Pain: A Contemporary Series of 40 Patients. Biomedicines. 2021 Jun 25;9(7):731. DOI: 10.3390/biomedicines9070731
Winter L, Saryyeva A, Schwabe K, Heissler HE, Runge J, Alam M, Heitland I, Kahl KG, Krauss JK. Long-Term Deep Brain Stimulation in Treatment-Resistant Obsessive-Compulsive Disorder: Outcome and Quality of Life at Four to Eight Years Follow-Up. Neuromodulation. 2021 Feb;24(2):324-330. DOI: 10.1111/ner.13232
Schwabe K, Alam M, Saryyeva A, Lütjens G, Heissler HE, Winter L, Heitland I, Krauss JK, Kahl KG. Oscillatory activity in the BNST/ALIC and the frontal cortex in OCD: acute effects of DBS. J Neural Transm (Vienna). 2021 Feb 3. DOI: 10.1007/s00702-020-02297-6
Rzesnitzek L, Hariz M, Krauss JK. Psychosurgery in the History of Stereotactic Functional Neurosurgery. Stereotact Funct Neurosurg. 2020;98(4):241-247. DOI: 10.1159/000508167
Akçakaya MO, Saryyeva A, Heissler HE, Hermann EJ, Krauss JK. Glial tumors and deep brain stimulation: An increasingly recognized association? J Clin Neurosci. 2019 Jun;64:1-3. DOI: 10.1016/j.jocn.2019.04.008
Lozano AM, Lipsman N, Bergman H, Brown P, Chabardes S, Chang JW, Matthews K, McIntyre CC, Schlaepfer TE, Schulder M, Temel Y, Volkmann J, Krauss JK. Deep brain stimulation: current challenges and future directions. Nat Rev Neurol. 2019 Mar;15(3):148-160. DOI: 10.1038/s41582-018-0128-2
Alam M, Sanghera MK, Schwabe K, Lütjens G, Jin X, Song J, von Wrangel C, Stewart RM, Jankovic J, Grossman RG, Darbin O, Krauss JK. Globus pallidus internus neuronal activity: a comparative study of linear and non-linear features in patients with dystonia or Parkinson's disease. J Neural Transm (Vienna). 2016 Mar;123(3):231-40. DOI: 10.1007/s00702-015-1484-3
Alam M, Schwabe K, Lütjens G, Capelle HH, Manu M, von Wrangel C, Müller-Vahl K, Schrader C, Scheinichen D, Blahak C, Heissler HE, Krauss JK. Comparative characterization of single cell activity in the globus pallidus internus of patients with dystonia or Tourette syndrome. J Neural Transm (Vienna). 2015 May;122(5):687-99. DOI: 10.1007/s00702-014-1277-0
At the MHH
Prof. Dr. Dirk Dressler, PD Dr. Christoph Schrader, Prof. Dr. Thomas Skripuletz (Clinical Department of Neurology)
Prof. Dr. Kirsten Müller-Vahl, Prof. Dr. Kai Kahl (Clinical Department of Psychiatry, Social- and Psychological Therapy)
External
Prof. Dr. Andrea Kühn (Clinical Department of Neurology, Charité Berlin)
Prof. Dr. Thomas Münte, Prof. Dr. Norbert Brüggemann (Clinical Department of Neurology, University of Lübeck)
Prof. Dr. Marc Wolf (Clinical Department of Neurology, Klinikum Stuttgart)
PD Dr. Christian Blahak (Clinical Department of Neurology and Neurogeriatrics, Ortenau Klinikum Lahr- Ettenheim)
Prof. Dr. Jens Volkmann (Clinical Department of Neurology, University Hospital Würzburg)
Prof. Dr. Lars Timmermann (Clinical Department of Neurology, University Hospital Marburg)
Prof. Dr. Rick Schuurmann, Dr. Pepijn van den Munckhof (University of Amsterdam)
Prof. Dr. Andres Lozano (University of Toronto)
PSR Medtronic
STIM-TOX
BOSTON DYSTINIA REGISTRY
ADVANCE II BOSTON
DYSTRACT
PC-S Berlin
TOURETTE DBS REGISTRY
Prof. Dr. Joachim K. Krauss(krauss.joachim@mh-hannover.de)
Dr. Assel Saryyeva(saryyeva.assel@mh-hannover.de)
Joachim Runge(runge.joachim@mh-hannover.de)