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Neurosurgeons and Pain Physicians: Effective Collaboration

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.

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Neurosurgeons and Pain Physicians: Effective Collaboration

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  1. 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

  2. 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

  3. Neurosurgical Neurostimulation • Deep brain stimulation • Motor cortex stimulation • Open peripheral nerve stimulation

  4. 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 Ablative Procedures

  5. 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

  6. Paddle Leads

  7. Why use paddles? • Previous difficulties with perc leads • Preference of implanter • ?lower current requirement • ?less interference by epidural fat

  8. 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.

  9. Guess the level!

  10. Communication is key T9 T10

  11. 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

  12. Neurosurgeons and Anesthesiologists • Consultants • Collaborators • Co-conspirators • Our skill sets both overlap and complement each other

  13. Thank you for coming! E-mail: jrosenow@nmff.org Phone: 312-695-0495

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