Often during our training, we would hear our seniors narrate stories of their training days. One intriguing tale was how a brain tumor was diagnosed and discovered during the surgery. This was during an era when technology played a minimal role in neurosurgery. The diagnosis of a patient’s brain tumor was based purely on the neurological presentation. With no CT scan or MRI available, they would be prepared for surgery based on this neurological examination. The surgery then undertaken was called ‘Exploratory Craniotomy’. This meant that during the surgery a large portion of the skull would be removed to reach the brain. Unaware of the exact location of the tumor, the neurosurgeon would now slowly run his finger over the naked brain to identify the lump just based on his finger’s feel. He would then carefully biopsy some portion of the brain, which he identified as the tumor, and send it for pathological examination. The resident or the trainee would run down to the pathology department and hand over the piece for examination. Often this piece would be identified as normal and the exercise would continue till the tumor was reached and removed.
ENTER TECHNOLOGY
The steady advent of technology changed the face of modern neurosurgery. With the arrival of CT scans and MRI, diagnosis of a brain or spine tumor became easier and surgery could be performed with more accuracy. With further advancement, the microscope was introduced and microsurgery added more precision to neurosurgery. For this branch, which is just about 100 years old, the last two decades have witnessed a technological revolution in neurosurgery. From an era of exploratory craniotomies, we are now looking at keyhole surgeries or sometimes even performing surgeries without actually entering inside the brain.
INNOVATION OVER THE YEARS
With technological innovations in neurosurgery occurring at such a fast pace, even trained neurosurgeons often find it challenging to keep pace with these changes. Multiple subspecialties are rising quickly in neurosurgery due to these advances. Some of the recent developments are:
Minimally invasive brain and spine surgery: With the introduction of endoscopes, keyhole surgery has become possible in neurosurgery. This has helped reduce morbidity and is cosmetically more suitable for patients.
Endovascular neurosurgery: Once considered an untreatable condition, endovascular neurosurgery has brought in a ray of hope for stroke patients. The morbid vascular lesions of the brain and spine can be treated with ease with this technological innovation without even making a cut on the brain.
Radiation oncology in neurosurgery: The role of radiation in brain and spine tumours is becoming more refined and focused. With advanced innovations delivering radiation to targeted regions of the brain has become possible while protecting the uninfected parts. Who would have predicted that some rays could possibly kill an entire brain tumor?
3D reprinting: Every case of spinal deformity is different and challenging. Treatment of these deformities is often complex and needs customization. With 3D reprinting coming into the picture, these deformities can be studied in more detail and a tailor-made treatment offered to patients.
Fetal neurosurgery: With early diagnosis of children with congenital brain and spine defects in the womb itself, intrauterine treatment of these lesions is being performed at many centers now. Fetal Neurosurgery is growing and overcoming the challenge of having an ill-formed nervous system before the birth itself.
WHAT DOES THE FUTURE BODE?
With neurosurgery changing every year, the future of technology and innovations to deal with the challenges in brain and spine surgery is inevitable. The future of neurosurgery will involve artificial intelligence (AI) right from training to performing neurosurgeries.
With robots taking over in a lot of surgical fields, robotic neurosurgery is not far away. Virtual reality will play a large role in the training of neurosurgeons. A larger number of doctors could be trained with more precision and uniformity.
Combining AI, VR, and the internet will not only enhance the training modules but also will make it possible to perform remote surgeries. Soon there will be surgeries that will be performed from one corner of the world into another which means while I sit in Mumbai, I could perform surgery in any remote village of India. Emergency neurosurgeries could be made available to everyone in time.
Neuroscience is one of the most rapidly evolving and researched branches today world over and a lot needs to be explored and discovered in this area. Recovering from neurosurgical ailments has always been prolonged and morbid. Till date, most neurological disorders are considered irreparable.
With new innovations coming into the picture, we are now looking at newer devices being made that can transmit signals from the nervous system to the organs directly. Neurosurgeons are implanting devices in diseases like Parkinson’s, for diaphragmatic paralysis to enhance breathing and a lot more.
Stem cell studies are progressing and heavily being studied. If success is met with these devices, we could overcome spinal cord injury and send signals across the damaged segment which would help the patient function normally.
Scientists have been researching and studying brain dead patients and the possibility of performing brain transplant surgeries. As in Indian mythology where Lord Shiva performed a brain transplant for his son Ganesha, a brain transplant could be a reality sometime in the future.