Hi, I'm Debbie Song. I'm a pediatric neurosurgeon at Gillette Children's Specialty Healthcare. Today, I'm going to be giving an overview of some of the neurosurgical interventions that can be done to address global tone in patients with cerebral palsy. Some of the common neurosurgical procedures that are done for patients with cerebral palsy include shunt surgery to treat hydrocephalus, intrathecal baclofen pump surgery for tone control, selective dorsal rhizotomy for global tone management as well, deep brain stimulation for treatment of dystonia, and also, ventral dorsal rhizototomy for treatment of hypertonia in terms of both spasticity and dystonia.
Selective dorsal rhizotomy, or SDR, is a neurosurgical operation that can permanently reduce muscle tone and eliminate spasticity in the lower extremities in select patients with cerebral palsy. Patients that we think of as being ideal candidates are typically patients who are born early. Oftentimes, those patients will have certain findings on their MRIs of the brain, so-called periventricular leukomalacia, which represents a little bit of volume loss in certain areas of the brain. The patients should have multi-level lower extremity spasticity, meaning spasticity or high muscle tone in multiple muscle groups in their lower extremities that's affecting their gait. It's also important that the patients have underlying strength. After a rhizotomy, we want them to be moving in a different pattern from where they were before surgery, and so usually the ideal candidate is someone who is between the ages of four and eight. There's a lot of post-operative therapy and rehab that goes in after selective dorsal rhizotomy, so they have to be able to cooperate with the therapies because it is a very intensive process.
Intrathecal baclofen pump is a device that delivers baclofen, which is a medication that can be used to treat spasticity into the spinal sac directly and continuously. It is most commonly used in patients with cerebral palsy that have hypertonia or high muscle tone in both their arms and their legs, so have some element of quadriplegic cerebral palsy. Usually they're not ambulatory and they can have both spasticity and dystonia. One of the advantages is that it's a fairly straightforward procedure. Surgery itself takes about an hour to do. The pump can be turned up and it can be turned down. It can even be turned off. If the effects of the pump are not ideal, then the pump can even be removed in certain circumstances.