Future Directions

Techniques such as fMRI and TMS, which do not require craniotomy, will be essential for the further development of less invasive techniques for treating neurosurgical disease. For instance, in order to perform endovascular, radio-surgical, or focused ultrasound procedures safely in the vicinity of eloquent cortex, an accurate preprocedure map is necessary. Therefore, the development of diagnostic brain mapping techniques should proceed in parallel to the development of new therapeutic techniques. Certainly, we can anticipate that the combination of more refined understanding of individual functional anatomy and less invasive techniques will open up entirely new avenues of neurosurgical treatment. One intriguing possibility is the use of imaging techniques to target the site of functional neurosurgical procedures. For example, the ongoing investigations into the neural basis of chronic pain may allow the further refinement of neurosurgical procedures for the treatment of pain. Already, fMRI has been used noninvasively to refine the target for epidural primor motor stimulation in the treatment of pain (109).

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