[Selective peripheral neurotomy and selective dorsal rhizotomy].

Although non-destructive neuromodulation is becoming popular, ablative neurosurgical procedures still play a very important role in the management of harmful spasticity. There are 2 major ablative surgeries for spasticity control. One is selective peripheral neurotomy that is indicated for focal spasticity such as equinus foot and inversion of the foot. Other indications are sciatic neurotomy for knee flexion spasticity, musculocutaneous neurotomy for elbow flexion spasticity, median nerve neurotomy for finger flexion spasticity and so on. The operative invasiveness of such procedures is small with several extraordinary advantage. Another well-established method is selective dorsal rhizotomy that is indicated for diffuse paraplegic spasticity in cerebral palsy children. Recent reports on randomized-controlled studies indicate its long-term effectiveness. A less invasive technique and intraoperative neurophysiologic assessment is important in selective dorsal rhizotomy to maximize clinical benefits and minimize complications. Surgical management of harmful spasticity is a very important and rewarding clinical practice, and should be one of the standards employed in clinical neurosurgical practice.