The emerging world of motor neuroprosthetics: a neurosurgical perspective.

A MOTOR NEUROPROSTHETIC device, or brain computer interface, is a machine that can take some type of signal from the brain and convert that information into overt device control such that it reflects the intentions of the user's brain. In essence, these constructs can decode the electrophysiological signals representing motor intent. With the parallel evolution of neuroscience, engineering, and rapid computing, the era of clinical neuroprosthetics is approaching as a practical reality for people with severe motor impairment. Patients with such diseases as spinal cord injury, stroke, limb loss, and neuromuscular disorders may benefit through the implantation of these brain computer interfaces that serve to augment their ability to communicate and interact with their environment. In the upcoming years, it will be important for the neurosurgeon to understand what a brain computer interface is, its fundamental principle of operation, and what the salient surgical issues are when considering implantation. We review the current state of the field of motor neuroprosthetics research, the early clinical applications, and the essential considerations from a neurosurgical perspective for the future.