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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 knowledge offered here.
The true miracle of the past 40 years regarding brain surgery
has to do with a number of factors:
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* 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.
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* Anatomic visualization (CAT scan, spiral CAT scanningMRI, MRAngiography,
digital angiography). These three dimensional recon-structions all use
improved computers. The surgeon can see almost ever, arteriovenous malfo
rmations, carotid artery narrowing). They 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.
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* "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 of the brain that would cause
trouble after the patient wakes up from surgery. He can safely go through
"quiet" brain on his path to the problem with full confidence knowing that
he will not damage the patient!
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* Better lighting. Seeing is always believing, especially if you're a surgeon
with a lot of experience and a hefty knowledge of what can possibly 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.
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* The operating microscope. Magnification in three dimensions allows even
those with the worst vision 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.
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* Coagulation instrumentation. Bleeding was 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, assuring no damage to surrounding brain), clotting agents
such as "gelfoam," "avitine" (microfibrillar collagen), oxidized cottons
and microvascular metallic clips of all shapes and sizes.
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* 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,
etc.), 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.
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* Simplicity. (This is my own personal bias, so take this with a grain
of salt. We generally avoid technology for technology's sake. If it simplifies
the work, we use it; if not, we tend to stay away from it.)
One of the most beautiful ironies of all 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:
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Shorten the time of operation. Operations that used to take 12 hours now
routinely take 1 - 2 hours, with better results!
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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.
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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).
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Improve patient outcome. Risks are reduced, and patients do much better.
You don't need to be "wiped out" by brain surgery any more. 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.
FOR NEW SURGICAL DEVELOPMENT FROM BRAINLAB, USING THEIR NEW COMPUTER GUIDED SYSTEMS IN THE O.R., PLEASE CLICK HERE.
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