Our research involves detailed analyses of craniocervical and spinal anatomical relationships and the development of novel instrumentation for stabilization of the spine. This work is performed in collaboration with the Stanford Anatomy Laboratory, Surgical Navigation Program and the Cyberknife Radiosurgery Program.

Current research projects include the following:

• Clinical outcome analysis of instrumentation for cervical fusion
• 3D Image Computer-Navigated Spinal Surgery
• Minimally Invasive Endoscopic Spinal Surgery
• Biomechanics of the Spine
• Spinal Fusion Utilizing BMP and GDF-5
• Nerve Growth Factor Studies
• Microsurgical Anatomy of the Spine and Peripheral Nerve
• Spinal Cord and Peripheral Nerve Regeneration Studies
• Radiosurgery for Spinal Tumors

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Specialties

Astrocytoma spinal disorders

Astrocytomas include a large group of gliomas whose predominant cell type resembles an astrocyte. Over half of all brain gliomas are astrocytic. They arise from and expand within the brain and almost never spread to other parts of the body. Astrocytomas are graded from grade I to IV depending on the presence of features implying rapid growth such as irregular cell structures, cells actively dividing, and abnormally formed blood vessels. Astrocytomas usually become clinically evident by virtue of seizure, headache, or focal neurologic deficits such as speech difficulty, motor weakness, and visual loss. Magnetic resonance imaging shows them to be a mass that replaces normal brain. Lower grade tumors are less likely to enhance (turn white) with intravenous contrast agents than are higher-grade tumors. Surgery is often indicated: to establish the diagnosis pathologically; to alleviate mass effects causing neurologic symptoms and deficits; to remove as much tumor as is safely possible in order to decrease the chance of lower grade tumors progressing to more malignant forms. Surgery is also performed to improve the safety and efficacy of other treatments such as radiation therapy, radiosurgery, and chemotherapy.

Cervical spondylosis

Cervical Spondylosis is degenerative change in the discs of the neck that leads to compression of the spinal cord or nerve roots. The cervical spine is susceptible to arthritic changes because of its mobility. Up to 50% of the population over 50 years old have arthritic changes and 20% will develop symptoms of cervical spondylosis. Symptoms include sharp stabbing pain and aches over the shoulders and down the arms and numbness or tingling over skin in the arms or hands. Changes in muscle strength and reflexes may also occur. More severe lesions can injure the spinal cord itself leading to difficulty walking, leg tremors, and loss of control of the bowel and bladder. An MRI is the diagnostic study of choice. Conservative management with analgesia, neck collars, and traction devices usually works well in the short term. Often, if the neurological deficits progress or intractable pain exists, an operation will be required. Usually, dramatic improvement of symptoms results.

Ependymoma spinal disorder

Ependymomas are tumors of the brain and spinal cord that arise from ependymal cells lining the central fluid spaces (ventricles) of the brain and the central canal of the spinal cord. They occur both in children and adults and constitute between five and ten percent of central nervous system tumors. More aggressively growing anaplastic ependymomas can be distinguished from more benign ependymomas by virtue of pathologic features such as irregular cellular shapes, greater cell density, and mitoses (cells in division). Ependymomas usually present with signs of increased intracranial pressure either from the size of the tumor itself or hydrocephalus (blockage of fluid flow) that results from the intraventricular location. Headache, lethargy, vomiting, and double vision are common. Seizure, facial numbness or weakness and difficulty swallowing can also occur. MRI usually shows a mass within the ventricles that turns bright with contrast. Given the tendency of ependymomas to spread through the brain and spinal fluid spaces, spinal MRI preoperatively and spinal fluid sampling (lumbar puncture) postoperatively are important in staging the spread of tumor. Surgical removal is the preferred treatment. The extent of resection possible is often determined by the pattern of tumor growth through the CSF spaces. Postoperatively, most patients receive fractionated radiotherapy. Whether the spinal cord as well as the brain is radiated depends on the pathology of the tumor and the results of staging. Chemotherapy is indicated in infants too young to undergo radiation therapy and in patients with recurrent growth of their tumor. The likelihood of tumor regrowth depends on the initial grade and extent of tumor, the extent of surgical resection, and the patient's age.

Hemangioblastoma spinal disorders

Hemangioblastomas are brain tumors derived from blood vessels. They represent approximately 2% of intracranial tumors and 10% of tumors in the posterior fossa. Hemangioblastomas are twice as frequent in men as in women. Approximately 5% of patients with hemangioblastomas have the dominantly inherited disease of Von Hippel-Lindau. Von Hippel-Lindau Disease is characterized by hemangioblastomas of the retina, cerebellum, and spinal cord, by tumors of the kidneys, and by cysts of the kidney, liver and pancreas. Approximately half of patients with the Von Hippel-Lindau disease gene have hemangioblastomas. Patients with Von Hippel-Lindau disease are more likely to have multiple hemangioblastomas than patients with a sporadic tumor. Both sporadically occurring and inherited tumors may produce erythropoietin, a hormone that causes over-production of red blood cells. Hemangioblastomas most commonly occur in the cerebellum, floor of the fourth ventricle, and spinal cord. They form as a solid tumor nodule, associated in the majority of cases with a cyst. Clinical symptoms and signs reflect the tumor's location. Posterior fossa tumors can cause headache and double vision from obstructive hydrocephalus, weakness in coordination, and gait instability. Spinal cord tumors can cause peripheral sensory loss, weakness, and gait difficulties. MRI clearly shows the brightly enhancing tumor nodule and the non-enhancing cyst. Surgical excision is the preferred method of treatment. Indications for surgery include relief of symptoms and removal of the risk of hemorrhage. Tumors that can only be partially removed by virtue of location or vascularity can be treated with radiosurgery or fractionated radiation therapy.

Meningioma spinal disorder

Meningiomas are tumors that arise from the dural coverings, the meninges, of the brain or spinal cord. They represent approximately 20% of intracranial tumors. They are twice as common in women as in men. The incidence of meningiomas increases with age; most occur in women in mid to late adulthood. Meningiomas occur at arachnoid granulations, sites of CSF absorption into the venous sinuses. In order of likelihood, these are the falx and parasaggital area, the convexity, the sphenoid wing and middle cranial fossa, the floor of the anterior cranial fossa, and the posterior fossa. Almost 90% of meningiomas are benign, slowly growing masses that produce symptoms by compressing brain or cranial nerves. Symptoms thus include headache, seizure, and focal neurologic loss of vision, strength, sensation, and speech. Except in the 10 to 15% of meningiomas that are atypical or malignant, growth is slow and progression of symptoms is insidious. Meningiomas have a highly characteristic appearance on MRI scans of a homogeneously enhancing mass with a dural tail. The preferred treatment for a symptomatic, enlarging, surgically accessible meningioma in a healthy person is surgical removal. In some cases, removal of the tumor may be facilitated by angiographic blockade (embolization) of the tumor's blood supply before surgery. Complete surgical removal provides cure or decades of local tumor control in almost all cases. In some cases, because of inextricable attachment to cranial nerves or critical blood vessels or because of the age or general health of the patient, complete surgical resection is not possible. Radiation either by radiosurgery or fractionated radiotherapy is then indicated. Small tumors, particularly in the elderly, are often quite indolent and can be observed radiographically without treatment. Evidence of growth that threatens the development of symptoms warrants treatment. Atypical or malignant features, found in 10 to 15% of cases, are usually considered indications for the addition of radiation even in completely removed tumors. The risk of tumor recurrence depends on the extent of the resection, which, in it's self, reflects tumor location.

Metastatic spinal tumor

A spinal tumor may be caused by the growth of abnormal cancer cells that have traveled to the spinal cord (metastasis). It could also be caused by rapid, uncontrolled division (proliferation) of normal cells of the area.

Spinal tumors are abnormal growths. They may occur in the spinal cord (intramedullary), within the meninges (membranes) covering the spinal cord (extramedullary, intradural), between the meninges and the bones of the spine (extradural) or may overlap in other locations. Most spinal tumors are extradural. They may be primary tumors originating in the spine, or secondary tumors that are the result of spread of cancer (metastasis) from other locations, primarily the lung, breast, prostate, kidney, or thyroid gland.

Any type of tumor may occur in the spine, including lymphoma, leukemic tumors, myelomas, and others. A small percentage of spinal tumors occur within the spinal cord, most often consisting of ependymomas and other gliomas. The cause of primary spinal tumors is unknown. Some primary spinal tumors are associated with congenital or hereditary tendencies. Spinal tumor is much less common than primary brain tumor.

The tumor affects the spinal-cord cells, nerve roots, meninges, blood vessels, or the bones of the spine. It causes symptoms because of compression of the spinal cord or nerve roots (similar to spinal cord trauma), invasion of normal cells by the tumor, or ischemia (lack of oxygen) that results from obstruction of blood vessels.

Courtesy National Institutes of Health

Neurofibroma spinal disorder

Neurofibromas are a symptom of neurofibromatoses, which are genetic disorders of the nervous system that primarily affect the development and growth of neural (nerve) cell tissues. These disorders cause tumors to grow on nerves and produce other abnormalities such as skin changes and bone deformities. The neurofibromatoses occur in both sexes and in all races and ethnic groups. Scientists have classified the disorders as neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2). Other or variant types of the neurofibromatoses may exist, but are not yet identified.

Courtesy National Institutes of Health, National Institute of Neurological Disorders and Stroke

Neurofibromatosis

Neurofibromatosis is a genetic disorder that can cause tumors in various parts of the nervous system. Neurofibromatosis type 2 causes multiple CNS tumors (including neurofibromas, bilateral vestibular schwannomas, and an increased risk of optic nerve gliomas). Treatment usually consists of surgery to remove tumors that are causing symptoms. The more common form of this disorder, neurofibromatosis type 1, usually causes benign tumors outside the CNS.

Radiculopathy

Radiculopathy is an irritation of one or more of the many nerve roots that exit the side of the spine along its length. It usually takes the form of a combination of pain, weakness, and numbness along the body region that the nerve root supplies. These regions are fairly consistent from person-to-person. This provides clues to the neurosurgeon for locating the level of the root injury. The most common symptom is severe pain along a particular part of the body. Radicular injuries are often confined to one side of the body (e.g. an arm is numb and lifting is difficult) whereas in a myelopathy in which the spinal cord itself is irritated, both sides of the body are affected. Lateral spinal disc protrusions and bony spurs are common causes of radiculopathy. They can be remedied by surgical removal of the disc or bony spur irritating the nerve root.

Schwannoma spinal disorders

Schwannomas and neurofibromas are tumors of the sheaths that surround cranial and peripheral nerves. The most common nerves involved are the eighth and the fifth cranial nerves producing vestibular schwannomas (acoustic neuromas) and trigeminal schwannomas, respectively. Vestibular schwannomas can occur either sporadically, on one side of a patient with no family history of such tumors, or as part of the dominantly inherited syndrome Neurofibromatosis type 2 (NF2). In the latter case, the patient will often have vestibular schwannomas on both sides and additional brain or spinal cord tumors. Acoustic neuromas present most commonly in young adulthood in NF2 and middle to late adulthood in the spontaneous form. Hearing loss, tinnitus (ringing in the ear), ear fullness, dizziness, vertigo, and unstable gait are all common. Larger tumors can cause headache, double vision, and unsteady gait, as well as facial numbness and difficulty swallowing. Enhanced MRI clearly shows tumor along the eighth nerve complex extending from the brainstem through the internal auditory canal toward the ear. Options for management include observation, surgery and radiation. Observation with close audiologic, neurologic, and MRI follow-up is a reasonable choice in patients with incidentally discovered tumors either with no, mild, or non-progressive symptoms. Enlargement of the tumor or progression of symptoms is an indication for treatment. Radiosurgery (focal radiation involving one to several treatment exposures) is an excellent option for small tumors (less than an inch in diameter) particularly in elderly or medically infirm patients. Surgery is often warranted in patients with large tumors compressing the brainstem, tumor enlargement following radiosurgery, rapid tumor growth, or high quality hearing. The choice of surgical approach -- suboccipital, translabyrinthine, and middle cranial fossa -- depends on the size of the tumor and the quality of the patient's residual hearing. Almost all of these tumors are benign and one or a combination of these treatments usually achieves long-term tumor control. Trigeminal schwannomas are similar except that their presentation, location, and treatment reflect their origin from the fifth rather than the eighth cranial nerve. They present with facial sensory loss, double vision, headache, weakness and gait instability. If large enough, they, too, may cause hydrocephalus. They may extend into the middle cranial fossa as well as the posterior cranial fossa and even into the cavernous sinus. The same treatment options apply. Generally, surgical removal of this benign tumor is preferred. Long-term control is usually possible. Other cranial nerves such as the vagal, glossopharyngeal, and hypoglossal nerves may also give rise to these tumors. Symptoms reflect the function mediated by the involved nerve and surrounding structures. Surgical treatment is usually preferred as it offers the opportunity for cure. Radiosurgery is often an acceptable alternative.

Spinal AVM disorder

Spinal arteriovenous malformation (spinal AVM) is similar to an AVM within the brain (see arteriovenous malformation above). It carries the same risk of hemorrhage as an AVM within the brain. This can cause significant neurologic deficits by injuring the spinal cord. These deficits include weakness or numbness in the arms or legs, difficulty walking, and loss of control of the bowel and bladder. Spinal AVMs can also cause neurologic deficits without bleeding by promoting congestion or swelling of the spinal cord, or by shunting or "stealing" blood away from the normal spinal cord. This results in similar symptoms. The diagnosis of a spinal AVM is made with a combination of MRI scans and spinal angiogram. Once diagnosed, spinal AVMs usually should be treated to prevent the risk of further hemorrhage or neurologic worsening. Treatment possibilities include surgical resection using a microscope and electrophysiologic monitoring. This allows complete removal of the AVM. Embolization (gluing of the vessels) of the AVM can also be performed in selected patients. Finally, at Stanford, we have developed a method to treat spinal AVMs with stereotactic radiosurgery using the Cyberknife(tm).

Spinal cord tumor

Spine tumors account for 15% of nervous system tumors. They may be primary or metastatic. Most primary tumors are benign. They cause symptoms such as pain and weakness by compression rather than invasion. They can exist outside the spinal cord sac (extradural), within the sac but outside the cord (intradural/extramedullary), or within the spinal cord itself (intramedullary). Metastatic tumors are more common. Most are extradural. Most spinal tumors present with pain. Pain can occur at the site (local) of the tumor or in the body, arms or legs in regions (radicular) supplied by the spinal nerves compressed by the tumor. Weakness of certain muscles as well as changes in sensation are also common with growing tumors. Difficulties with bowel and bladder function occur with more advanced tumor growth. These symptoms are generally slow to develop, but can occasionally manifest abruptly. An MRI is the best means of identifying a spinal cord tumor. Depending on the location and type of tumor and the general condition of the patient, many of these tumors can be treated with surgery or radiosurgery.

Spinal stenosis

Spinal stenosis is a condition where the spinal canal is too narrow for the nervous tissue within it. In the cervical and thoracic canal this will cause spinal cord compression which may result in weakness of the legs, sensory loss below the level of the narrow spine, or impairment of control of the bowel or bladder. In the lumbar spine this may cause "Lumbar Spinal Stenosis" (see below for description). Spinal stenosis is best diagnosed with MRI scanning. Spinal stenosis may occur on a congenital basis, that is people may be born with a canal that is too narrow, or it may be degenerative, in which it occurs in conjunction with disc disease.

Spine tumor (bone)

Spinal bone tumors are uncommon neoplasms originating from the bone. They tend to appear in older individuals and present with localized pain at the site of the lesion. Bone scans are very accurate in locating the abnormality. Osteoid osteomas are slow-growing tumors that cause pain and, rarely, neurologic deficits. Osteoblastomas are more aggressive bone tumors that tend to bleed easily. Vertebral hemangiomas are benign tumors that often respond to radiation therapy. Myeloma is a disease that often afflicts multiple bones in the body, including the spine, by causing erosive lesions. Pain from spinal bone tumors can be significantly relieved by surgical removal. Without surgery, progressive growth will cause symptoms to worsen.

Tethered spinal cord

Tethered spinal cord refers to a spinal cord that lies at a lower level in the back than is normal. As the bones of the spine grow faster than the spinal cord within, an abnormally short and thickened piece of tissue (the filum terminale) that anchors the spinal cord to the bottom of the spinal canal stretches the spinal cord into a lower position than usual. This condition usually affects children who often have other congenital spinal abnormalities such as scoliosis and myelomeningocele. These children have difficulty walking and abnormal sensation in their lower extremities. Bladder function is also often compromised. Unlike children, adults with this condition usually have pain. They also share lower extremity weakness and bladder dysfunction. If this condition is causing symptoms, surgery to release the spinal cord from the tethering tissue can alleviate some symptoms and prevent progression.

Brachial plexus

Brachial plexus is a complex web of nerves found in the lower neck and upper back that branches into the nerves that run down the arms to the hands. These nerves control the muscles and sensation of the upper extremities from the shoulder to the fingers. Injuries to one or more of these nerves can result in significant loss of function. Extensive injuries can result in a completely useless arm. These injuries are most commonly due to direct blunt or sharp trauma or traction on the arm. Tumors compressing the nerves and radiation can also injure the plexus. Brachial plexus injuries require prompt referral to a surgeon who has special training and experience with the complex anatomy and repair of the brachial plexus and its nerves to maximize the potential for recovery.

Carpal tunnel syndrome

Carpal tunnel syndrome is the most common entrapment neuropathy of the upper extremity. As the median nerve travels into the hand through a tunnel of tissue, a tight, thickened ligament may compress it across the base of the palm called the flexor retinaculum. Most patients are middle-aged women and 50% have symptoms bilaterally. This condition may be associated with repetitive wrist motion, obesity, pregnancy, or other medical conditions. Patients often complain of waking at night with painful numbness of the hands that improves with shaking the arms. Wasting of hand muscles and clumsiness is also noted. Nerve conduction studies can help make the diagnosis. Treatment is focused on the underlying causes. When this fails, operative division of the flexor retinaculum will relieve symptoms in most patients.

Cervical thoracic and lumbar disc disease

Unlike cervical spinal stenosis or narrowing of the spinal canal, pure protrusions of the disc are rare at the cervical level. These tend to occur in younger patients and are secondary to a specific incident such as a sudden injury or trauma. Symptoms are related to irritation of a nerve or spinal cord level that causes pain, weakness, and/or numbness anywhere from the shoulder to the fingers on one side or both. Pain in the neck limiting motion is almost always present. The continuing symptoms can cause tremendous distress and discomfort for the patient. Though conservative management can alleviate a majority of minor cases, surgical intervention is usually definitive and produces excellent results.

Fibrous dysplasia

Fibrous dysplasia is a benign expansion of one or more bones of the skull base. It can present as facial deformity, headache, or loss of cranial nerve functions such as vision and eye movement. It usually presents in the second decade of life and is often self-limited. CT scan is very helpful in identifying the bone changes. Surgery is rarely needed and radiation therapy should never be used.

Hemangioma

Also called cavernous hemangioma, the classically recognized hemangioma is a visible red skin lesion that may be superficial in the skin (in the top layers, called a capillary hemangioma), deeper in the skin (cavernous hemangioma), or a mixture of both. Hemangiomas are usually present at birth although they may appear within a few months of birth often beginning at a site that has appeared slightly dusky or colored differently than the surrounding tissue.

Hemangiomas, both deep and superficial, undergo a rapid growth phase in which their volume and size increase rapidly. This phase is followed by a rest phase, in which the hemangioma changes very little, and an involutional phase where the hemangioma undergoes spontaneous regression. During the involutional phase, hemangiomas may disappear completely. Large cavernous hemangiomas distort the skin around them and despite full involution, will ultimately leave visible changes in the skin. The more superficial capillary hemangioma may involute completely, leaving no evidence of its past presence.

Hemangiomas may be present anywhere on the body. However, they are most disturbing to parents when they are on the infant's face or head. Hemangiomas of the eyelid may interfere with the development of normal vision and must be treated in the first few months of life. On rare occasions, the size and location of hemangiomas may interfere with breathing, feeding, or other vital functions. These lesions also require early treatment.

Large cavernous hemangiomas may develop secondary infections and ulcerate. Bleeding is not uncommon and may be significant following injury to the hemangioma.

Courtesy National Institutes of Health

Lumbar spinal stenosis

Lumbar spinal stenosis is narrowing of the lower spinal canal that compresses the nerves traveling through the lumbar canal into the legs. Although occasionally seen in younger patients from developmental causes, it is usually a degenerative condition seen as part of the normal body aging process that develops when patients are age 60 or older. Common symptoms include: dull to severe aching pain in the lower back or buttocks that develops with walking or other activities and pain that radiates into one or both thighs and legs. Many patients become more sedentary in an effort to control their pain. An MRI scan is the best screening test to evaluate if someone has this disorder. For temporary relief, conservative treatments include anti-inflammatory medications, physical therapy, and steroid injections. For long term relief and improved quality of life - surgery that removes the lamina from the back part of the canal is the choice.

Peripheral nerve tumors

Peripheral Nerve Tumors; Schwannoma/Neurofibroma are tumors of the cells that surround the axons of nerve cells. They can occur anywhere that a nerve travels from the spinal cord to the distant extremities. They are generally rare and tend to cause symptoms by direct compression of the nerve. This results in pain or sometimes weakness and numbness along a part of the body to which the nerve travels. Neurofibromas may be part of a larger disease process called neurofibromatosis. Neurofibromatosis is a set of diseases divided into Type 1 and Type 2 classes. These tumors are genetically inherited disorders that consist of multiorgan malformations and tumors. Type 1, or Von Recklinghausen's disease, is an embryological disorder resulting in combinations of light brown skin patches, superficial nerve tumors, large pink skin tags, scoliosis, mental retardation, and multiple tumors of the brain, eye, blood, and endocrine organs. Type 2 disease is characterized by bilateral auditory nerve sheath tumors sometimes found with other tumors. Most of these are familial and can be detected by DNA analysis. Neuromas may be resected surgically. Schwannomas are found in people 30-60 years old. Complete operative removal can often be accomplished; however, the nerve may be so encased that injury to the nerve is a risk.

Spine trauma or fracture

Spine trauma or injury to the spine is very common in trauma, especially those involving motor vehicle accidents and falls. Injuries can range from simple strains to catastrophic disruption the spinal cord incompatible with life. Symptoms from very slight injuries can progress to alarming disability. It is important that any painful injury to the back be evaluated quickly. The crucial aspect in managing these injuries is prompt identification of the injury. A stable injury or fracture including strains and fractures such as small compression and wedge fractures are generally treated conservatively with observation and support devices. An unstable injury requires immediate attention to the amount of neurological injury and methods for stabilization. Depending on the location and type of injury, many different measures are employed, including non-operative stabilization and surgical fixation. These measures all attempt to prevent further injury to the spinal cord, which can lead to significant disability and death.

Subependymal giant cell astrocytoma

Subependymal giant cell astrocytomas are relatively benign tumors that arise from cells just beneath the lining of the ventricles. About half occur in patients with tuberous sclerosis, approximately fifteen percent of whom have subependymal giant cell astrocytomas. Their ventricular location can cause hydrocephalus which produces headache and lethargy as initial symptoms. Patients who have tuberous sclerosis may have already presented clinically with seizures or mental retardation. MRI scan shows a tumor that enhances brightly after contrast arising from the wall of the lateral ventricle. Surgery is indicated in an effort to completely remove the tumor and re-establish CSF flow. Radiation therapy is reserved for patients with inoperable tumor regrowth or malignant change.

Takayasu's arteritis

Takayasu's arteritis is a form of vasculitis (see below) that can partially or completely occlude the blood vessels leading to the brain. If this occurs, stroke (see above) or temporary symptoms which can mimic a stroke can occur. Treatment is similar to that for vasculitis with the exception that surgical treatment and endovascular treatment using stents (thin metal sheets placed within the vessel) are more likely to be considered.

Tarsal tunnel syndrome

Tarsal tunnel syndrome results when a ligamentous band compresses the posterior tibial nerve as it passes around the inner aspect of the ankle. Old ankle injuries can predispose to this condition. Symptoms include burning pain and numbness along the sole of the foot and the toes, which often spares the heel and weakness of toe flexion. In cases that do not resolve, surgical decompression of the nerve at the ankle can result in dramatic relief.

Torticollis

Torticollis is a form of dystonia (movement disorders with prolonged muscle contractions) in which the neck muscles, particularly the sternocleidomastoid muscle, contract involuntarily causing the head to turn. Torticollis may occur without known cause (idiopathic), be genetic (inherited), or be acquired secondary to damage to the nervous system or muscles.

Torticollis can occur at any age, although most individuals first experience symptoms in middle age. It often begins slowly and usually reaches a plateau. About 10 to 20 percent of those with torticollis experience a spontaneous remission, but unfortunately the remission may not be lasting.

No one treatment has been found universally effective. Instead, physicians use a variety of therapies aimed at reducing or eliminating muscle spasms and pain.

Ulnar palsy

The ulnar nerve may be injured at the elbow by elbow dislocation or by compression by a traversing band of tissue as it passes along the inner aspect of the elbow (entrapment). Symptoms include weakness and wasting of the muscles of the little finger and deformity of the hand into a characteristic lobster claw appearance. Nerve studies can help assess the injury to the nerve. Surgery can free the trapped, damaged nerve and relieve symptoms.

Vagal nerve stimulators

Vagal nerve stimulators are currently best used to treat medically intractable complex partial seizures. However, many physicians are using them for other types of epilepsy with good results. . In patients who are not candidates for open, traditional resective surgery, a vagal nerve stimulator may be used. This implanted device, attached to the left vagus nerve, has been shown in multiple studies to reduce the seizure frequency and intensity by 50% or more in 30% of the patients nine months after the onset of stimulation. With additional stimulation (i.e., greater than 18 months), 54% of the patients develop a 50% or better reduction in seizure frequency and intensity. The procedure itself takes approximately one and a half-hours, and the patients usually go home the next day. The procedure has very few risks.