Functional Neurosurgery at the University Medical Center Ljubljana

Introduction Surgical treatment of spasticity, chronic pain, and movement disorders represents an emerging field of neurosurgery in Southeast Europe and, therefore, regional availability of these state-of-the-art therapies might be suboptimal.

Aim The aim of the presentation is to outline the working specter of the functional surgery program at the University Medical Center in Ljubljana.

Material and Methods A review of medical documentations of all patients treated for spasticity, chronic pain, or movement disorders from 2007 until now at our institution was performed.

Results Since the introduction of deep brain stimulation in Ljubljana in June 2014, we have to date performed 13 first implantations (7 cases of Parkinson disease, 4 cases of dystonia, and 2 cases of essential tremor) and 9 impulse generator exchanges. In April 2014, treatment of chronic pain, mostly related to failed back surgery syndrome, has formally began in Ljubljana; since then, six trial stimulations have been performed and four permanent stimulators have been implanted. Treatment of severe spasticity with intrathecal baclofen has the longest history among neuromodulation therapies in Slovenia, as the first baclofen pump was implanted in 2001. Currently, there are 71 patients with baclofen pump in Slovenia; 41 of them are male and the average age is 41.6 years. The average daily dose of baclofen is 325 mcg and patients usually need to come for a reservoir refill three times yearly.

Conclusion The aims of our multidisciplinary neurofunctional unit are to provide state-of-the-art therapy for ∼40 patients yearly, among them 15 patients with movement disorders, 10 with chronic pain, and 15 with spasticity. Besides providing most of the functional neurosurgical procedures to Slovenian population, we also wish to establish our unit as a regional center of excellence and to offer our therapies to other regions of Southeast Europe, where they might not be as readily available.

Keywords functional neurosurgery; neuromodulation; deep brain stimulation; chronic pain; spasticity