Brain Surgery Today
Brain surgery continues to instill enormous fear in everyone, even the most placid of individuals. Perhaps these fears can be allayed with some of the facts offered here.
The true miracle of the past 40 years regarding brain surgery is based on the following advancements:
- Diagnostic accuracy allows the surgeon to work precisely where he or she wants to work with amazing efficiency and reliability, each and every time. The result is that the surgical incision has been reduced to an absolute minimum. Smaller incisions, less tissue trauma, and better surgical planning have reduced the risk of brain surgery from almost 90% in the 1940’s to about 2% in the 1990’s.
- Anatomic visualization (CAT scan, spiral CAT scanningMRI, MRAngiography, digital angiography). These three dimensional reconstructions all use improved computers. These imaging techniques include: Transcranial doppler, S.P.E.C.T. (single photon emission tomography), Xenon cerebral blood flow studies, blood flow MRI etc. Thus, the surgeon can predict and avoid blood supply problems prior to surgery.
- “Functional” Imaging Studies (Functional MRI, Magnetoenceph-alography, EEG mapping studies, angiographic “stress” tests, e.g. the Wada test). All of these studies can help the surgeon avoid trouble after the patient wakes up from surgery. He can safely work through the “quiet” brain on his path to the problem with full confidence knowing that he will not damage the patient.
- Better lighting. Seeing is always believing, especially if you’re a surgeon with a lot of experience and extensive knowledge of what can go wrong during an operation. With current lighting technology, even a very small and extremely deep approach to a brain lesion can be seen in the equivalent of broad daylight.
- The operating microscope. Magnification in three dimensions allows the surgeon to see every thing with astounding clarity. Recognition of vital structures is now routine, no matter how small they might be. The result has been a dramatic reduction in operative error.
- Coagulation instrumentation. Bleeding is almost never a problem for the brain surgeon. The need for blood transfusions has been almost eliminated, except for certain vascular lesions (e.g. brain aneurysms and certain rare tumors). The surgeon can stop bleeding reliably and easily with such instruments as the “bipolar forceps” (electric coagulation between the two ends of a fine instrument, ensuring no damage to surrounding brain), clotting agents such as “gelfoam,” “avitine” (microfibrillar collagen), oxidized cottons and microvascular metallic clips of all shapes and sizes.
- Intraoperative guidance systems. Just as the space shuttle is guided in mid-flight, so the hand of the surgeon can be guided in mid-operation. Stereotactic guidance systems (involving surface markers or “frames,” computers), three dimensional computer-assisted guidance systems (via infrared lights, lasers, mechanical arms, radiotelemetry), even real-time imaging such as intraoperative ultrasonic guidance systems and MRI, and finally computer-guided mechanical arms (hands free) are all available to today’s surgeon.
One of the most beautiful ironies of this technology is that it allows the surgeon to minimize everything. It is now possible to do all of the following, in a more complete and accurate manner:
- Shorten the time of operation. Operations that used to take 12 hours now routinely take 1 – 2 hours, with better results!
- Spare the normal brain. In other words, the down side of brain surgery has been greatly reduced. “Exploratory” surgery no longer exists. The “music lessons” are almost always preserved. Patients rarely wake up with new neurologic problems.
- Do a better job. Total removal of tumors and vascular lesions is now possible. With primary brain tumors, 90-99% removal is now really possible with preservation of surrounding eloquent brain. (This was only a dream in the past).
- Improved patient outcomes. Risks are reduced, and patients do much better. You don’t need to be “wiped out” by brain surgery anymore. It is not uncommon for patients to leave the hospital two days after their surgery. In other words, brain surgery does not have to be traumatic; furthermore, it is a most successful tool in the treatment of brain diseases.
NEW SURGICAL DEVELOPMENTS FROM BRAINLAB, USING THEIR NEW COMPUTER GUIDED SYSTEMS IN THE O.R. Watch Below