Neurosurgery is one of the newest surgical specialties. Many of the great surgeons in the 19th and even 20th century felt that brain operations for tumors were not possible. Considering a brain surgery mortality rate of 50 -70%, this is not surprising. Thanks to advances, including the introduction of medications to reduce the severity of brain swelling, brain surgery has seen an incredible evolution over the past fifty years. With the advent of medication, brain surgery mortality almost instantly dropped to 20%.
Even after the introduction of medications, visibility remained a steep challenge for neurosurgeons — that is, the ability to see through the narrow opening of the skull and through the critical structures of the surrounding brain. This, specifically, is what makes neurosurgery very different from most other types of surgery. Neurosurgeons cannot safely move structures out of the way.
As neurosurgery has become more “mainstream,” the specialty has seen inventions that have aided surgeons in their visibility challenge, further helping surgeons advance their techniques and success rates. In fact, it is the camera (first invented in the 17th century with the first photographic click taking place in the early 1800s), and the technology of the camera, that has helped transform brain surgery. Here’s how…
Endoscopes: The advent of high precision microscopes allow the combination of high magnification and bright light. Now neurosurgeons frequently combine this technology with endoscopes allowing us to direct a small camera with high magnification through the narrow corridors of the critical structures of the brain. These two pieces of technology truly complement each other. A surgeon can also help safely navigate the endoscope through the brain by looking back and forth from the microscope. Truly symbiotic.
Exoscope: This latest invention is best described as many endoscopes combined with a microscope — there is a larger light and lens that looks down on the patient from above. Plus, ergonomically an exoscope’s design is advantageous to the surgeon, making procedures less fatiguing.
Guided Image: A third major advance in brain surgery has been the use of image guided technologies. All neurosurgeons walk into the operating room with a rehearsed set of mental images of the patient’s brain; those images conjured are based on the surgeon’s study of the patient’s MRIs and Cat. Image guided surgery goes beyond the doctor’s mental images, providing surgeons with a GPS-like system of the patient’s brain. The imaging is created by cameras that give off infrared light — similar to the satellites used for GPS in a car. This light is reflected off of glass bead coated markers that are placed on surgical instruments further allowing the surgeon to “navigate” in real time. Imaged-guided technologies allow surgeons to look at the actual brain and the MRI of the brain at the same time.
With new inventions based in part on the technology of the camera, surgery will likely continue to be less invasive and safer for the patient. There is no doubt that the future is bright for technology applications in brain surgery.