Surgery of the Autonomic Nervous System

 

Description:

Autonomic surgery is an important and expanding field within contemporary clinical practice. Surgical therapies influencing the autonomic nervous system have historically entailed disabling various components of its network by injurious methods. More sophisticated techniques have now emerged to allow modulation of neural function by electrical implants or by preservative surgery. This has fuelled the expansion in this field as safer therapies with greater scope for patient benefit have become available. As the potential for precise neural manipulation has advanced, so has the number and diversity of diseases which have become amenable to such therapies. This book reviews the basic science underpinning the autonomic control of various body systems and the state-of-the-art clinical applications by which these systems are surgically modulated in patients today. Clinical chapters include details of the procedure, operative considerations, outcomes, adverse effect profile, post-operative management of such patients and reflections on personal experience. Autonomic surgery can be applied to a wide variety of diseases affecting large numbers of the population such as angina pectoris, hypertension, orthostatic hypotension, sexual dysfunction, regional pain syndromes, headache and epilepsy.

 

 

Table of Contents:

 

 

 

1. Neural control of the heart and cardiovascular system

 

Introduction

Central and intra-thoracic cardiovascular autonomic architecture

Central autonomic network

Cortical control of the cardiovascular system

Subcortical control of the cardiovascular system

Medullary control of the cardiovascular system

Sympathetic efferents

Neural determinants of cardiovascular performance

Baroreceptor reflex

Chemoreceptor reflex

Feedback and feedforward pathways associated with exercise

Baroreceptor reflex

Central command

Exercise pressor reflex

Mechanisms associated with behaviour

Conclusions

References

2. Baroreceptor activation therapy: A surgical approach to the treatment of hypertension

Introduction

Pathophysiological aspects of essential hypertension

Baroreceptor function in hypertension

Electrical stimulation of the baroreflex

Early experiments in animals

Early experiments in humans

Recent developments

Acute effects of the Rheos System in humans

Chronic effects of the Rheos System in humans

Baroreceptor activation therapy and target organ damage

Future developments

Conclusions

References

3. Deep-brain stimulation and blood pressure disorders

Introduction

The technique of deep-brain stimulation

Brain stimulation and blood pressure

Why the PAG is important—using the opportunity of DBS

What are the mechanisms of the BP changes?

What are the underlying central nervous system mechanisms?

Dorsal versus ventral electrodes

What is the likelihood that DBS will be used to treat BP related conditions?

Other brain areas and other systems involved in autonomic control

The respiratory system

Gastrointesinal system

Urinary system

Pedunculopontine nucleus region

Conclusions

References

4. Lateral medullary decompression for essential hypertension

Introduction

Why do we need arterial blood pressure anyway?

The sympathetic system in neurogenic hypertension

Is there an inflammatory role in the origin or maintenance of neurogenic hypertension?

Neurogenic hypertension—where is it broken?

Neurogenic hypertension—the clinical phase

Conclusions

References

5. Device-based approaches to target renal sympathetic nerves for hypertension

Introduction

Therapeutic targeting of sympathetic nerves: a brief historical overview

Role of the sympathetic nervous system in cardiovascular and metabolic control

The specific role of renal sympathetic nerve activity in hypertension

Recent surgical and device-based approaches to target SNS overactivity

Surgical intracranial neurovascular depression

Devices for regulating breathing

Deep-brain stimulation

Stimulation of the arterial baroreceptor with an implantable device

Transcatheter renal nerve ablation

Renal nerve ablation as treatment for drug-resistant hypertension

Symplicity HTN-1

Symplicity HTN-2

Symplicity HTN-3

Potential future indications for renal nerve ablation

Insulin resistance

Congestive heart failure

Chronic and end-stage renal failure

Obstructive sleep apnoea

Atrial fibrillation

Alternative approaches to achieve renal denervation

Saline-irrigated radiofrequency ablation catheters

Radiofrequency ablation catheters

Intra-vascular ultrasound catheters

Peri-vascular pharmacologic ablation

Conclusions

References

6. Evolution and developments in autonomic control of the heart I: the neurocardiac axis

Introduction

Historical and evolutionary concepts on the role of the nervous system on cardiac performance

Pertinent anatomy and physiology (including humoral control) of afferent and efferent autonomic nervous system in cardiac functioning

Cardiac autonomic nerves

Afferent cardiac nerves

Overview of experimental models of neural hierarchy in ischaemic heart disease

The emerging function of the nervous system in the development of atherosclerosis and the putative humoral path from the heart to the brain

Atherosclerotic disease and nervous pathways

Pathophysiology of the nervous system and the heart

Angina and the ischaemic heart: defining the problem of atherosclerotic diseases

Angina and atherosclerotic disease

Chronic refractory angina

Acute coronary syndromes

Arrhythmias

Heart failure

7. Evolution and developments in autonomic control of the heart II: therapeutical interventions

Introduction

Brief historical perspective of neuromodulation for cardiac diseases, executed by ablative therapies and modulation of neurones

Surgery of the autonomic system

Modulation of the autonomic system

Rationale for target selection and approach of modulation of the nervous system in the management of cardiac diseases

Accepted and emerging cardiac indications for electrical neuromodulation

Angina and electrical neuromodulation and patient selection

Heart failure and electrical neuromodulation

Arrhythmias and electrical neuromodulation

Technical details of neurostimulation procedures

Outcomes of spinal cord stimulation on cardiac diseases

Chronic angina refractory to standard therapies

Screening tools for patients

Efficacy

Safety

Mechanisms of action

Acute coronary syndromes

Heart failure

Arrhythmias

The future: further improvements in integrative approaches on interfaces between heart and nervous system

Conclusions

References

8. Periarterial sympathectomy in the treatment of upper extremity peripheral vascular disease

Introduction

History of periarterial sympathectomy

Current principles of periarterial sympathectomy

Pathophysiology

Patient selection and technique

Outcome

Conclusions

References

9. Spinal cord stimulation for complex regional pain syndrome I: mechanisms

Historical perspective

Anatomy, physiology, and disease pathophysiology

The nociceptive pathway

How does SCS work?

Local neurochemistry

Gamma-aminobutyric acid (GABA)

Serotonin

Acetylcholine (ACh) and noradrenaline

Summary of SCS mechanism

Disease pathology of CRPS

Aetiology and epidemiology

Pathophysiology

Peripheral sensitization

Central sensitization

Sympathetic nervous system

Genetic factors

Brain plasticity

Inflammatory factors

Psychological factors

Treatment overview

SCS and CRPS

SCS and sympathetic nervous system

What the future holds

Conclusions

References

10. Spinal cord stimulation for complex regional pain syndrome II: clinical applications

Introduction

Rationale for target selection and approach

Target levels

Postural effects

SCS systems

Indications and patient selection criteria

Implant procedure details

Review of clinical outcomes

Clinical effectiveness

Cost-effectiveness

Complications

Conclusions

References

11. Trigeminal autonomic cephalalgias I: peripheral neuromodulation (occipital nerve and sphenopalatine ganglion stimulation)

Introduction

Pathophysiology of trigeminal autonomic cephalalgias

The trigeminal autonomic reflex and hypothalamic activation

Occipital nerve stimulation

Anatomy of the occipital nerves

Operative techniques

Evidence for efficacy of ONS in primary headache syndromes

Cluster headache

SUNCT and SUNA

Sphenopalatine ganglion stimulation

Anatomical basis of the autonomic phenomena in trigeminal autonomic cephalalgias

Evidence for sphenopalatine ganglion stimulation in chronic cluster headache

Safety of peripheral neurostimulation

Mechanism of action of peripheral neurostimulation

Conclusions

References

12. Trigeminal autonomic cephalalgias II: deep-brain stimulation of the posterior hypothalamus for chronic cluster headache

Introduction

Anatomy and physiology of the posterior hypothalamus

Posterior hypothalamus chronic high-frequency stimulation and cluster headache

Surgical methodology of posterior hypothalamus DBS

Long-term results of posterior hypothalamic stimulation in chronic cluster headache patients

Conclusions

References

13. The central nervous system in control of continence and sexual functions

Introduction

Micturition

Bladder afferents and efferents

Spinal–midbrain–spinal loop

Forebrain control—role of the emotional motor system

Defecation

Rectal afferents and efferents

Spinal–midbrain–spinal loop

Forebrain control—role of the emotional motor system

Ejaculation

Spinal afferents and efferents

Spinal–midbrain–spinal loop

Pelvic floor stimulating centre

Forebrain control—role of the emotional motor system

Parturition

Spinal afferents and efferents

Spinal–midbrain–spinal loop

Forebrain control—role of the emotional motor system

Conclusions

References

14. Pudendal nerve stimulation

Introduction

The pudendal nerve

Anatomy of the pudendal nerve

Pudendal nerve stimulation

Surgical access to the pudendal nerve

EMG recordings for ensuring correct electrode placement

Dorsal genital nerve stimulation

Mechanism of action

Experimental studies

Clinical results

Clinical experience with DGN

Other indications

Conclusions

References

15. Sacral nerve stimulation for lower urinary tract dysfunction

Introduction

Historical overview

Indications

Over-active bladder

Urinary retention

Neurogenic bladder dysfunction

Functional bowel disorders

Pelvic pain

Mechanism of action

Neuromodulation technique

Clinical results

Follow-up and adverse events

16. Neuromodulation for faecal incontinence and constipation

Introduction

Disease burden of faecal incontinence and chronic constipation

Role of neuromodulation in the treatment algorithm of faecal incontinence and chronic constipation

Sacral nerve stimulation

Patient selection and work-up

Treatment technique

Test stimulation

Permanent stimulation

Clinical outcomes

Faecal incontinence

Quality of life after permanent SNS

Chronic constipation

Physiological outcomes

Rectal motor effects

Rectal sensory effects

Other rectal effects

Anal motor effects

Anal sensory effects

Percutaneous tibial nerve stimulation

Patient selection and work-up

Treatment technique

Clinical outcomes

Physiological outcomes

Pudendal nerve stimulation

Patient selection and work-up

Treatment technique

Clinical outcomes

Physiological outcomes

Conclusions

References

17. Gastric stimulation for obesity and gastroparesis

Introduction

Gut electrical stimulation for gastroparesis

Equipment and implantation procedure

Clinical experience with gut electrical stimulation

Mechanisms of gastric electrical stimulation

Areas of uncertainty

What the future holds

Electrical stimulation of the lower oesophageal sphincter for GERD

Human studies of LOS electrical stimulation

Chronic Human Studies

Areas of uncertainty

What the future holds

Gastric Electrical Stimulation for Obesity

Clinical experience with Electrical Stimulation for Obesity

Transcend Implantable gastric electrical stimulation device

The Tantalus™ Implantable gastric electrical stimulation Device

Vagal Nerve Blockade Therapy System

What the future holds

18. Hyperhidrosis: pathophysiology and available therapies

Introduction

Epidemiology

Pathophysiology

Medical therapy

Anticholinergics

Iontophoresis

Botulinum toxin injections

Surgical treatments

Pre-operative work-up

History and evolution of surgical sympathectomy

Minimally invasive sympathectomy

Nuances of surgical sympathectomy

Description of thoracoscopic sympathectomy

Risks associated with surgical sympathectomy

Compensatory hyperhidrosis

Other surgical risks

Conclusions

References

19. Vagus nerve stimulation in the treatment of epilepsy I: history, vagus nerve physiology, and putative mechanisms

Introduction

Epilepsy and the autonomic nervous system

The need for alternatives to medical therapy in the treatment of epilepsy

Electrical stimulation of the vagus nerve for medically intractable epilepsy

Evidence supporting use of vagus nerve stimulation in managing intractable epilepsy

The E01 and E02 pilot trials

The E03 randomized controlled trial

The E04 open-label compassionate use trial

The E05 randomized controlled trial

History of vagus nerve stimulation for the treatment of epilepsy

Anatomic and physiologic considerations

Background

Proposed mechanisms of action

Choice of left versus right vagus nerve stimulation

Areas of controversy and uncertainty

Lack of clear mechanism of action

Inadequacy of evidence on efficacy of vagus nerve stimulation for treatment of epilepsy

Animal studies

Human clinical trials

Lack of objective outcome metrics for therapeutic response

Lack of a dose–response relationship between stimulation parameters and clinical response

Lack of double-blind placebo-controlled trials: ineffective blinding

Natural history of intractable epilepsy, a relapsing-remitting condition, and implications for assessing efficacy

Summary

20. Vagus nerve stimulation in the treatment of epilepsy II: procedure, evidence, and adverse events

Introduction

Patient selection

Devices used in vagus nerve stimulation

Operative procedure

Peri-operative care

Operative technique

Generator replacement

Lead replacement

Post-operative follow-up and stimulator programming

Complications and adverse effects of vagus nerve stimulation

Vocal cord and pharyngeal effects

Cardiac rhythm disturbances

Skin breakdown

Sleep-related breathing disorder

Magnetic resonance imaging of patients with vagus nerve stimulators

Conclusions

References

Index

 

An aparitie	14 April 2016
Autor	Jonathan A. Hyam, Erlick A. C. Pereira, Alexander L. Green
Dimensiuni	24.89 x 2.29 x 17.53 cm
Editura	Oxford University Press
Format	Hardcover
ISBN	9780199686407
Limba	Engleza
Nr pag	352