David Darrow, MD

New in Neurosurgery: 23-year MVD series (n=523) for Type 1 TN ~70% pain-free at 15 yrs — highly durable • Worse outcomes in women → phenotype/diagnostic mixing? • Vein sacrifice: small risk, more complete decompression journals.lww.com/neurosurgery/f… @NeurosurgeryCNS

Perhaps the most provocative implication: Some patients classified as “TN with continuous pain” or TN2 may actually represent temporomandibular disorders rather than primary trigeminal neuralgia. We have known for a while but now the discourse begins! journals.lww.com/neurosurgery/f…

Daryl Fields, @yiluspine , and Joe Neimat put on a fantastic course Modulating the spinal cord for #spinalcordinjury amongst many other disorders is just the beginning for a true partnership of @spinesection @painsection and @ASSFNeurosurg for the greater good!

While it was certainly different to attend a spine conference #spinesummit as a pain and functional neurosurgeon, I was honored to contribute to the stellar momentum for the future of functional in spine surgery

targeting the gasserian ganglion is challenging from an anchoring perspective and these leads are tricky to get just right. Despite this there is real potential for such an isolating pain disorder @facialpainassoc

This raises a novel idea: Can we modulate central targets (e.g., thalamus) through the remaining afferent fibers? Instead of only targeting the brain directly like we have found beneficial through cortical stim #Neuromodulation

Our case report on percutaneous trigeminal ganglion stimulation for refractory anesthesia dolorosa is now live. #Neurosurgery #PainMedicine all inspired by Nick Boulis journals.lww.com/neurosurgpraco…

Thank you @U2FP_CureSCI for inviting me to talk about the future of #neuromodulation for #spinalcordinjury. It is always a different view from the stage! This year really galvanized a cohesive direction for the future

I have been at a loss for words. Sanjeet was not only a colleague & my main collaborator, but also one of my best friends. His enthusiasm to push the boundaries of science were unmatched. So little of our work would have been possible if it weren’t for his openness and bravery to do something new, but also his patience with us as we worked through MANY challenges! Sanjeet was a true advocate and pioneer for what we do in imaging, particularly our functional and 7T fields. He always sought even the tiniest advantage he could have to ensuring his patients have the best outcome. It is hard to express the impact his loss will have on his family, friends, colleagues, and medicine.

A truly tragic loss. Sanjeet was such an amazing person, physician, neurosurgeon, and friend amongst many. It was a privilege to know and work alongside him. My heart goes out to his family and everyone touched by his kindness and expertise during this incredibly difficult time.

We are excited to be a part of this community to further efforts to understand and treat #bipolardisorder where we hope to bring biological insight back to psychiatry @UMNews @umnneurosurgery with @ZiadNahas7 @DrDamienFair @TNetoff @AlexHermanMDPhD @HermanDarrowLab

@ELHELOUA @HermanDarrowLab @umnneurosurgery Thank you Antonios!

@daviddarrow @HermanDarrowLab @umnneurosurgery Fantastic Job David!!

This is the future. The reality of biological #psychiatry. We listen to the patient, create a personalized map of their brain, use algorithms to disrupt stuck networks, and adapt the stimulation over time while continuing our quest to understand those networks. @umnneurosurgery

@DrDamienFair It is a massive team effort at @UMNews with @umnneurosurgery Michael Park, Psychiatry, @UMNBME @UMN_MIDB

This is the #Neurosurgeon who perfected the process to integrate seamlessly into typical workflows. Driving the work in both depression and pain…#AllHandsOnDeck 👇🏾👇🏾👇🏾👇🏾

And it isn't about invasive stimulation. It is a tool that we have amongst many and has its uses. But at the same time it sets the stage for validating noninvasive stimulation approaches. We can do invasive stimulation for those who truly need it. #depression

This is exactly the point and why the goal is to intervene at all possible levels with neuromodulation whether cortical stim #dbs #tms #ultrasound and also why understanding behavior is critical to understanding our patients in #pain @AlexHermanMDPhD

So, we examined it in our prior cortical stimulation patients. Two patients with central neuropathic pain. * One had electrodes over both SCAN & AMN. *One hit only SCAN. Pain relief tracked exactly with network engagement. Precision matters!!!!

Figure 1 (attached) shows how these networks: • Interdigitate with traditional motor areas • Align closely with pain activations (r=0.73) • Vary dramatically between individuals These are non-sensory pain networks. That’s why classic targeting misses.

Two newly characterized brain networks are critical: * SCAN (Somato-Cognitive Action Network) * AMN (Action-Mode Network) These aren’t just "motor" or "cognitive" areas. They are core pain-processing hubs, tightly linked to action planning and control.