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The science of neurosurgery entails treating illnesses and disorders originating in the nervous system, especially the brain and spinal cord. "Over the past few decades, a technological upsurge in medical science has resulted in development of state-of-the-art equipment, advanced surgical approaches and contemporary techniques to treat various neurological disorders, allowing surgeons to operate on portions of the brain with minimal incisions, providing reliable accuracy and better patient outcomes," says Dr Mahesh Choudhary, consultant neurosurgery, SL Raheja Hospital, Mahim -- A Fortis Associate.
The term 'minimal invasive neurosurgery' was first coined by Dr Donald Wilson around 1971. While traditional open brain surgeries are still being performed depending on the patient's prognosis, the popularity of minimally invasive surgeries (MIS) has grown significantly, says Dr Choudhary.
According to him, the procedure involves laparoscopic devices and remote-controlled manipulation of surgical instruments with observation of the surgical field through a scope, either micro or endo. "In traditional brain surgeries, surgeons and neurosurgeons make large incisions to treat any brain-related problem. With MIS, specialists make only small openings to insert sophisticated video equipment and robots to perform the surgery," he explains.
"Also known as 'keyhole' or 'neuroendoscopic' surgery, MIS aims to remove brain tumours with minimal disruption to the surrounding healthy brain tissue. The process uses specialised instruments and techniques to access and remove the tumour through small incisions in the skin or natural body openings, such as the nostrils or mouth," says Dr Choudhary.
Eyebrow craniotomy: It is used to remove certain brain tumours in or under the frontal lobes and around the area of the optic nerves and above the pituitary gland. During this type of procedure, incision is made in the eyebrow, allowing the surgeon access to the brain's frontal region. In most cases, a high-definition endoscope is used to enhance the images of the brain so that the surgeon can ensure safe tumour removal. An operating microscope alone cannot provide these types of visual imaging that a high-definition endoscope machine can.
"Transnasal surgery using an endoscope with a definition camera has revolutionised skull base surgery. Skull base tumours like pituitary, craniopharyngioma, sellar, tuberculum sellae meningiomas, and chordomas are routinely operated with this approach," the expert states.
Retromastoid: This technique uses a small window behind the ears to reach and remove various types of cancerous growth, including acoustic and trigeminal schwannomas, meningiomas, epidermoid tumours, and tumours of the cerebellum such as hemangioblastomas and metastatic brain tumours. It involves using an endoscope. This operation has been shown to have good clinical outcomes as it is associated with excellent access to the pathology with minimal cosmetic or soft-tissue damage and relatively fast patient recovery.
Minimally-invasive craniotomy: Some brain neurological disorders, including tumours and blood clots, can be present in the deep regions of the brain. During standard brain surgery, there is a high risk of damage to healthy tissues and nerves. A minimally invasive craniotomy allows surgeons access to areas deep inside the brain with minimal cuts to the skin. In addition, it allows neurosurgeons to conduct biopsy/excise intraventricular tumours, employing complex treatment methods like third ventriculostomy and aqueductoplasty. It also can be used for proper placement of the ventricular shunt tube.
The doctor explains that in most MIS procedures, there is a reduced chance of post-operative trauma for the patient as it causes less post-operative pain and scarring. "For patients, MIS can lead to less post-operative pain and discomfort with less use of pain relievers and short hospital stays with a quicker return to the usual way of life; smaller incisions than traditional surgeries and less muscle pain or damage."
For surgeons, MIS ensures better visualisation of the brain and spine, leading to better accuracy and success, he concludes.