Major advances in brain surgery
When you hear about advancements in brain surgery, it’s often a report of a new technology, surgical approach, or technique. But just as important are new ways of thinking that lead to shifts in how patients are cared for.
Neurosurgery is the medical specialisation of treating diseases and disorders of the nervous system, especially the brain and spinal cord. Neurosurgery has been practised throughout human history, but the most important neurosurgery breakthroughs have only come about in the last century. These changes continue to make neurosurgery safer and patient recovery time shorter.
Over the last few decades, surgeons have learned so much about how the back and the brain work together. Along with medical researchers, scientists and engineers, physicians have made immense advances in surgical procedures. Surgery used to be extremely long, invasive and painful, but today, you can be in and out of surgery in a short time.
Dr Brandon Davis, neurosurgeon and neuro-interventionalist at Memorial Healthcare System, said there is a multidisciplinary approach to treatment that has made a significant difference in expanding the horizon of neurosurgery. Some of the technologies, he said, are completely new, and others have undergone a lot of reforms to reach their present state.
“Although revolution has been brought by the use of CT scans, recent advances like intra-operative ultrasonography, stereotactic radiosurgery, use of stem cells, 5-ALA, deep brain stimulation, can possibly change the face of neurosurgery in the future,” Dr Davis said.
In the past few years, there has been an increased demand for use of neuro-navigational systems in neurological operation theatres. These have become necessities for superior resection of neural lesions. Intra-operative CT scan and MRI are in place, but the feasibility of these tools in resource-limited setting is doubtful.
“Ultrasonography is a transducer device that uses reflective property for image buildup. The most useful one is the phase array transducer, that uses small acoustic lenses which are rectangular in shape with area of contact being 20 to 25 mm. Use of USG rose to its height in the 1990s in other medical specialities, but its use in neurosurgery was in infancy period. However, today it is taking pace and is commonly used for localisation of mass lesions,” Dr Davis said.
In recent years, it is also clear that technologies advanced by the field of robotics have been incorporated into the operating room through microscopy, navigation, instrumentation, optics, and imaging.
“The use of a mechanical device, whether through automation or remote control, to ultimately manipulate the instruments directly in contact with a patient is relatively new to brain and spine surgery. However, there is a growing interest in this field, and its potential clinical benefits have encouraged the development of multiple systems,” Dr Davis noted.
Also, according to the neurosurgeon, while initial treatment after a stroke is vital, follow-up care with a neurologist is also important. They can provide ongoing care and support to stroke survivors and help them regain as much function as possible.
In addition, neurologists can help identify any lingering effects of stroke and provide advice on how to manage them. For all these reasons, it is important for stroke survivors to see a neurologist after leaving the hospital. With the right care, stroke survivors can often make a good recovery and return to a better level of function.
“The neurologist will monitor your condition and make sure that you are receiving the best possible care. They can also offer advice on lifestyle changes that may help you recover from your stroke. They can help assess the damage caused by the stroke, and develop a treatment plan to help improve function and reduce the risk of another stroke,” Dr Davis said.
There has been tremendous progress in the modern-day technologies, causing a rapid evolution in the field of neurosurgery. The neurosurgeons have been equipped with the latest advancements, such as the use of robotics in surgery, the image-guided neurosurgical procedures, and stereotactic neurosurgery.
In addition, the pre-operative screening techniques have drastically improved the success of the surgical procedure. Neuronavigation has allowed the precise localisation of the deep-seated brain structures, thereby helping in the accurate operation of the affected regions without stirring the normal brain tissues. Such preciseness has helped in the improvement of the patient outcome.
Dr Davis was a speaker at the 21st Caribbean Neurosciences Symposium, hosted by the Caribbean Neurological Association in collaboration with the Department of Surgery, Radiology, Anaesthesia, Intensive Care at The University Hospital of the West Indies, held at the Half Moon Resort in Montego Bay from February 9-12
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