Study of the brain has fascinated specialists all over the globe since time immemorial. The brain being the most vital organ for survival and coordination is perhaps the most complex of them all too. This has led to a limited understanding of its working in spite of the available advanced technology. However, with the advent of techniques for diagnosis and treatment, therapeutic strategies are evolving. This is a major step towards rendering Neurosurgery safer than ever in the history of mankind.
Neurosurgery through the 20th Century-
During the beginning of the 20th century, Neurosurgery was considered as a specialty. The clinical-neurologist would draw conclusions related to lesions in the brain through neurological examination and clinical history. It enabled diagnosis of vascular lesions, spinal disorders, and brain tumors. During the second and third decades of the 20th century, vascular pathologies and brain tumors could be diagnosed indirectly through techniques like angiography, ventriculography, and pneumoencephalography. But since the operative techniques were too crude and the lack of skilled professionals were rampant, there were high rates of morbidity and mortality due to neurological conditions. Generally, after diagnosing the nature of brain lesion and its site, surgery was performed with inadequate maintenance and control of intracranial pressure and through not too sophisticated surgical instruments.
During the fifth and sixth decades of the 20th century, chemotherapy and radiation treatment came into the picture for treating malignant brain tumors, thereby reducing mortality to a good extent.
During the seventh decade of the 20th century, Computed Tomography (CT) scan provided a better understanding of the location of lesions in the brain which slightly substantiated the earlier techniques. Then, the procedures for cerebrospinal fluid diversion significantly improved management of intracranial pressure during surgery.
It was only during the last decade of the 20th century that the Neurology saw a giant progressive leap through the introduction of Magnetic Resonance Imaging (MRI) and powerful high magnification microscopes. Combined with Neuroanesthesia and Intracranial Pressure Management, this aided surgeons to work on a relaxed brain. This promoted safe removal of the brain tumor and better management of vascular lesions. Moreover, the understanding of micro-surgical anatomy improved drastically, leading to a boost in confidence levels of the micro-neurosurgeons performing the operation.
Neurosurgery in the 21st Century-
The 21st century is actually a revolutionary era that uses powerful computers in almost all the fields possible. Computer-based applications such as Neuro-imaging, Neuronavigation, Intra-operative Neuro-monitoring, and Neuro-modulation are now used in standard neurosurgical practice as a part of the routine. Extremely powerful CT scans and MRIs are used for diagnosis before surgery. The advent of nanotechnology and its application in Neurosurgery is doing great and has a promising future ahead based on the current study of scenarios. Moreover, there is a possibility of most of the Neurosurgical procedures becoming minimally invasive. Frameless Stereotaxy is another technique that helps in locating the exact position of the tumor, which further helps the neurosurgeon in navigating with great precision the very sensitive, high-risk areas of the brain. Such techniques, to a great extent, have lowered mortality and morbidity, lessened the rate of recovery, and chances of infection related to Neurosurgery.
A number of techniques for diagnosis and precise location of the tumor in the brain have made Neurosurgery much safer today, due to advancement in science and technology, than it ever had been in the history of mankind.
Keyhole neurosurgery or endoscopic surgery has changed the neurosurgery scene. Open surgery is fraught with complications, which can be avoided with keyhole surgery. This is why this kind of surgery is preferred by most surgeons and fills the patients with relief too because they have to endure less pain.
What is Keyhole Surgery?
During keyhole surgery, the surgeon makes a small incision in the region where the surgery is to be performed. Through this hole, a lighted stick called an endoscope with a high-resolution camera is inserted. The device is equipped with an eyepiece through which the surgeon looks. The light illuminates the inside of the passage and the camera sends images that can guide the surgeon. Through another similar incision, delicate surgical instruments are inserted and the surgeon utilizes these to cut or amputate the tumour.
Throughout the duration of the surgery, you will be unconscious because general anaesthesia will be administered.
What are the Different Kinds of Keyhole Neurosurgery?
Keyhole Brain Surgery
A hole is made above your eyebrows or the surgeon may choose to insert the endoscope through your nasal cavity or even the mouth.
This surgery is suggested to people who have been diagnosed with-
Keyhole Spinal Surgery
Traditionally open surgery is relied upon for treating spinal disorders. But, this kind of surgery causes tears in the tissues and muscles of the spinal area. Advancement in technology has allowed surgeons to opt for keyhole spinal surgeries.
During this procedure, a tubular retractor is used to drill a hole into the spine and it also holds the muscles apart without causing a tear. Just like in brain surgery, the endoscope is used to guide the surgeon who performs the necessary procedure.
Keyhole spinal surgery might be needed in cases of-
Development of bone spurs on the spine
What are the Benefits of Keyhole Neurosurgery?
Here are the reasons why keyhole neurological surgeries are popular-
They reduce the possibility of infections developing at the site of the surgery
Patients heal a lot faster
These surgeries do not damage the adjacent tissues or blood vessels
Keyhole neurosurgery has ushered in a new era of surgical intervention. Wherever possible doctors try to recommend these endoscopic procedures.