Functional Neurosurgery

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Dr Keith Goh

What Is Functional Neurosurgery

Functional Neurosurgery is a specialised field within neurosurgery focused on improving or restoring the functionality of the nervous system. A range of surgical techniques to are available to address disorders that impact the normal functions of the brain, nerves, and spinal cord.

Common Conditions Treated by Functional Neurosurgery

Functional neurosurgery provides treatment for a diverse range of conditions that disrupt normal neurological function.

  • Cerebral Ischaemia: This refers to conditions where there is insufficient blood flow to the brain. Examples include moya-moya disease, (a cerebrovascular condition), and post-traumatic cerebral atrophy, which occurs following brain injury. These conditions can lead to various neurological deficits.
  • Epilepsy: Epileptogenic lesions are specific areas in the brain that cause seizures. Surgical interventions involve removing these lesions to reducel or even eliminate seizure activity.
  • Spasticity: This condition, often a result of cerebral palsy, trauma, or stroke, causes muscle stiffness and involuntary spasms. Treatment includes rhizotomy, where irritable nerve roots are divided to relieve spasticity, or the placement of intrathecal baclofen pumps to deliver medication directly to the spinal fluid.
  • Hyperhidrosis: Excessive sweating, particularly in the palms, can be debilitating. Thoracoscopic sympathectomy, a minimally invasive surgery, is performed to treat this condition.
  • Facial Hemispasms: These are characterised by involuntary twitching or contractions of the facial muscles. This condition is typically treated by microvascular decompression to relieve pressure on the facial nerve.
  • Peripheral Nerve Lesions: These lesions can cause a range of symptoms, including pain, weakness, or loss of function in the arms or legs. Treatment involves specific surgical approaches tailored to the type and location of the lesion.

Causes of
Functional Neurological Conditions

The causes behind functional neurological conditions are varied and can be broadly classified as follows:

  • CerebroVascular Disorders: Some conditions, like moya-moya disease, are caused by blocked or narrowed arteries. This can lead to reduced blood flow to the brain.
  • Genetic Predisposition: Some conditions, especially those with focal epileptogenic lesions, may have genetic predispositions.
  • Traumatic Brain Injury: This can lead to post-traumatic cerebral atrophy, affecting brain function.
  • Developmental Disorders: Cerebral palsy, a result of birth insults (such as meningitis or brain haemorrhage) or abnormal brain development, often leads to spasticity.
  • Neurological Disorders: Peripheral nerve lesions can be caused by various neurological diseases, such as tumours or trauma, impacting nerve function and health.

Symptoms and Signs

The symptoms and signs associated with functional neurological conditions vary and include:

  • Pain: Neuropathic pain can be a clinical feature in peripheral nerve lesions.
  • Muscle Stiffness and Spasms: Common in spasticity, often resulting from cerebral palsy, trauma, or stroke.
  • Excessive Sweating: This is a symptom commonly seen in patients with hyperhidrosis.
  • Involuntary Muscle Contractions: Seen in conditions like facial hemispasms.
  • Seizures: A primary symptom of epilepsy, especially when caused by focal brain lesions or brain damage.
  • Weakness and Cognitive Changes: Often observed in patients with cerebral ischemia and cerebral atrophy.


Diagnosis of functional neurological conditions involves a comprehensive approach which typically includes the following:

  • Medical History and Physical Examination: Diagnosis typically begins with a thorough review of the patient’s medical history and a physical examination. This helps to identify symptoms, their onset, and progression, and any relevant personal or family medical history.
  • Imaging Tests: MRI, CT or PET scans can help visualise the brain’s structure and function. They can reveal abnormalities such as lesions, areas of ischemia, or structural anomalies.
  • Neurophysiological Studies: Electroencephalography (EEG) is used in diagnosing epilepsy, capturing electrical activity in the brain to identify epileptogenic zones. For peripheral nerve lesions, nerve conduction studies and electromyography assess the electrical conduction of nerves and muscle response.
  • Laboratory Tests: Blood tests can uncover underlying metabolic or genetic conditions that might contribute to neurological symptoms. They also help rule out other diseases that can mimic neurological disorders.

Surgical Treatment Methods

Various surgical methods are employed in functional neurosurgery, tailored to specific conditions:

  • Indirect or Direct Cerebral Revascularization: Procedures like encephalo-duro-arterio-synangiosis (EDAS) and encephalo-myo-synangiosis (EMS) involve creating new vascular pathways to increase blood flow to the brain. They are often used in conditions where cerebral arteries are narrowed or blocked, such as in moya-moya disease.
  • Omental Transposition: This procedure is rare and typically reserved for specific cases. It involves transplanting a portion of the omentum, a fatty layer in the abdomen, to the brain. The rich blood supply of the omentum helps improve cerebral circulation.
  • Lesion Resection: This is the surgical removal of epileptogenic lesions in the brain, a targeted approach to control and potentially cure epilepsy.
  • Rhizotomy: A surgical procedure to divide the roots of spinal nerves, specifically targeting those contributing to abnormal muscle contractions and stiffness in spasticity.
  • Thoracic Sympathectomy: A minimally invasive procedure aimed at treating palmar hyperhidrosis by cutting or clamping the sympathetic nerves responsible for excessive sweating, particularly in the palms.
  • Baclofen Pump: Involves implanting a pump that continuously delivers the muscle relaxant Baclofen directly into the spinal fluid, providing relief from severe spasticity.
  • Microvascular Decompression: This surgery involves relieving pressure on cranial nerves caused by abnormal contact with blood vessels, commonly used to treat conditions like trigeminal neuralgia and hemifacial spasms.

Recovery and Rehabilitation

Postoperative care is initially centred around managing pain, ensuring proper wound healing, and monitoring for any complications. Patients often engage in physical rehabilitation programs tailored to their specific needs, particularly in cases involving spasticity or nerve surgeries. These programmes can help restore and enhance motor functions.

Regular neurological monitoring is another component of the recovery process, allowing for timely detection of changes or improvements in neurological function. Lifestyle adjustments, including modifications in daily activities and exercise routines, can also play a role in facilitating healing and preventing complications post-surgery.

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Dr. Keith Goh






With more than 20 years of experience in the field of Neurosurgery, Dr Keith Goh’s subspecialty includes treatment of brain and spinal cord tumours and pediatric neurosurgery.

He is the Medical Director of International Neuro Associates, which is based at Mount Elizabeth Medical Centre, and provides specialist neurological services to all the hospitals within the Parkway Pantai hospital group. He also was Honorary Associate Professor of Neurosurgery at the Prince of Wales Hospital of the Chinese University of Hong Kong.

  • Bachelor of Medicine & Surgery — National University of Singapore
  • Neurosurgical Residency at the Chinese University of Hong Kong
  • Advanced specialty training in paediatric neurosurgery at the Beth Israel Institute of Neurology & Neurosurgery in New York

His bibliography includes 40 original articles, 11 book chapters, and 104 abstracts and lectures on his various research interests, such as brain tumours, spinal cord tumours, head trauma, conjoined twins and congenital malformations in children.


Mount Elizabeth Medical Centre,
#09-10, 3 Mount Elizabeth
Singapore 228510

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    Frequently Asked Questions (FAQ)

    What Should I Avoid After Functional Neurosurgery?

    Postoperative instructions typically include avoiding strenuous activities, specific body positions, or certain medications that might interfere with recovery. Follow the guidance given to you by your neurosurgeon for a smooth recovery process.

    Can I Exercise After Functional Neurosurgery?

    The resumption of physical activity varies among patients and must be approached under individualised medical guidance. Discuss with your neurosurgeon for a safe exercise plan customised to your specific condition and health status.

    How Can I Prepare for Functional Neurosurgery?

    Preparation includes several steps: completing preoperative assessments, understanding the surgical procedure, arranging for postoperative care, and maintaining a healthy lifestyle to support recovery. Your neurosurgeon will provide you with specific guidelines before your surgery.