Jagid, Jonathan R., M.D.
Assistant Professor

Functional Neurosurgery

Overview
A wide range of activity takes place in the department involving the treatment of disorders such as epilepsy and Parkinson's disease by using stereotactic techniques which allow precise targeting of both abnormal and normal brain areas. A variety of hardware including MRI-compatible stereotactic frames and frameless stereotactic neuronavigation equipment is employed. Stereotactic radiosurgery using the Gamma Knife® is an active program described in a separate section of this website.

Epilepsy
Many patients with epilepsy do not achieve adequate seizure control with medications alone. These seizure disorders may be a result of brain injuries from trauma or related to other disorders such as malformations of areas of brain tissue. In some of these patients the onset of the seizures can be localized to limited areas of brain tissue that may be relatively safely removed. Localization of these seizure foci requires extensive evaluation by a multidisciplinary team involving neurologists, neurosurgeons, psychologists, and radiologists. The University of Miami School of Medicine International Center for Epilepsy offers comprehensive evaluation and management to adult and pediatric patients with seizure disorders.

At the Epilepsy Center, surgical procedures are performed only after an in-depth evaluation is completed. Identification of the epileptic area may, when appropriate, be accomplished using surgically implanted epidural, subdural and depth electrodes in conjunction with EEG/video monitoring.

In some cases, intra-carotid methohexital (or Wada) testing may be necessary before surgery to determine hemispheric speech dominance and memory function. The surgical resection is usually completed under local anesthesia. Functional mapping and electrocorticography by electrical stimulation of the cortex is then routinely performed. Thus, the critical language, motor and sensory areas of the cortex can be identified and the resection tailored to exclude these important areas.

Some patients with intractable epilepsy are not good candidates for removal of a seizure focus but may be appropriate for other operations such as corpus callosotomy, multiple subpial transection, or vagus nerve stimulation.

Movement Disorders
The department maintains an active program in surgery for movement disorders such as Parkinson's disease and essential tremor. Previous surgery and research involved making small lesions in deep areas of the brain, but recently, the work has centered on insertion of devices to provide ongoing electrical stimulation of these deep brain areas. Patients that have inadequate response to medications are evaluated in depth by a team of neurologists and neurosurgeons prior to a decision on surgery.

Stimulators are placed stereotactically under local anesthesia with MRI-based targeting and detailed electrical mapping. Stimulators may be placed in the thalamus, subthalamus, or globus pallidus depending on the patient's circumstances.

Other Procedures
Stereotactic biopsy may be an appropriate part of the management of intracerebral tumors; the management of tumors is described more in the neuro-oncology section. Occasionally other neurologic disorders, such as infection, may warrant stereotactic biopsy. Stereotactic radiosurgery with the Gamma Knife® is covered in a separate section of this website.