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Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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Updated: May 7, 2026

Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain
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Epidural and subdural stimulation.

V Tronnier1, D Rasche

  • 1Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany.

Handbook of Clinical Neurology
|October 12, 2013
PubMed
Summary
This summary is machine-generated.

Implanted cortical stimulation offers long-term treatment for neuropsychiatric disorders when transcranial methods fail. Epidural and subdural electrode placement are key for conditions like pain, depression, and stroke rehabilitation.

Keywords:
Parkinson’s diseasedepressionextraduralintraduralpainrehabilitationstimulationtinnitus

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Area of Science:

  • Neurosurgery
  • Neurology
  • Biomedical Engineering

Background:

  • Cortical stimulation via transcranial or implanted electrodes is increasingly used for neuropsychiatric diseases.
  • Implanted electrodes offer long-term benefits where transcranial stimulation provides only short-term success.
  • Epidural stimulation is established for chronic pain, with emerging applications in movement disorders, tinnitus, depression, and post-stroke rehabilitation.

Purpose of the Study:

  • To review the applications and considerations of epidural and subdural cortical stimulation.
  • To highlight the role of computational models in optimizing epidural stimulation parameters.
  • To discuss the trade-offs between stimulation efficacy and complication risks for different electrode placements.

Main Methods:

  • Review of current literature on epidural and subdural cortical stimulation techniques.
  • Discussion of computational modeling approaches for stimulation parameter optimization.
  • Analysis of clinical outcomes and complication rates associated with different stimulation methods.

Main Results:

  • Implanted electrodes provide sustained therapeutic effects for various neurological and psychiatric conditions.
  • Computational models aid in understanding stimulation geometry and optimizing parameters, including the influence of the cerebrospinal fluid layer.
  • Subdural/intrasulcal stimulation allows for focused delivery and lower currents but carries increased risks of seizures and hemorrhages.

Conclusions:

  • Cortical stimulation, particularly with implanted electrodes, is a valuable therapeutic modality for complex neuropsychiatric conditions.
  • Optimizing stimulation parameters through modeling and considering anatomical factors like CSF is crucial for maximizing efficacy.
  • Careful patient selection and monitoring are essential to mitigate the risks associated with invasive stimulation techniques.