Interventional neurophysiology and an implantable system for neurostimulation of the sacral area

Surgical or interventional neurophysiology is a term commonly used to refer to a large number of neurosurgical procedures involving the brain, cranial nerves, spinal cord and peripheral nervous system which, to be efficient and safe, demand specific neurophysiological know-how. As a result of the development of these procedures and their increasing use in the operating room, the role of clinical neurophysiology, traditionally diagnostic, has been extended. With the advent of 'neurostimulation' and 'neuromodulation', some neurophysiological techniques have, in themselves, progressively become more therapeutic, the therapeutic alteration of nervous system activity being achieved not only by surgical ablation or medication but also through electrophysiological means via implanted or non-implanted devices, whose development was made possible by extensive studies in the field of neurophysiology. The first application of electrical stimulation in urology opened up the way for progress in the therapeutic direction. Moreover, with regard to the mechanism of action underlying neuromodulation, the application of neurophysiology and neuroimaging procedures has contributed to understanding of the neural control mechanism of visceral (e.g. lower urinary tract) function. In our experience, the advent of sacral neuromodulation for lower urinary tract dysfunction and the use of neurophysiology has made it possible to shed light on the pathophysiological mechanisms of neuro-urological disorders, allowing us to assess and validate new therapeutic approaches and finally to develop a new method and device for chronic pudendal nerve stimulation.