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Neurosurgery

Trephination to Transplantation

From trephination to transplantation, neurosurgery has come a long way indeed, to levels of sophistication that could not have been imagined even a decade ago.

Back then in the era of trephination, neurosurgeons struggled in the face of impossible odds pertaining to localization, illumination, magnification, instrumentation, bleeding and infection. Morbidity was, therefore, unacceptably high.


 

Technical advances in the last few decades, however, have dramatically swung the balance in favour of doctors, bringing mortality rates down to extremely low levels.

From sophisticated imaging tools like C T Scan and MRI, which are a boon to making accurate diagnosis, surgeons are now armed with a battery of cutting edge tools that provide three-dimensional information and help them plan their surgical strategies.
Beyond this advanced MRI spinoffs like FMRI and DTI (diffusion tensor imaging) or Tractography support and guide them through a procedure with live images of the brain.

The advent of the microscope has heralded a new era of mcroneurosurgery, oriented to microsurgical anatomy and microinstrumentation.

Meanwhile new illumination and magnification technologies have lit up even the darkest and remotest nooks of the brain making them accessible to the surgeon. Advances in developmental optics have made neuro-endoscopy possible and this is now being used for intraventricular and pituitary surgeries.

Stereotactic surgery is based on the principal of approaching a target with planned co-ordinates. Such breakthroughs have taken the concept of micro-neurosurgery to an all-new plane of refinement.

Microelectrode technology has made instant intra-operative physiological verifications possible and new therapies like DBS (Deep brain stimulation), VNS (Vagal Nerve Stimulation) and SNS (Sacral Nerve Stimulation) have had a profound impact on successful treatment and management of extremely serious brain conditions.

With the invasion of technology, modern operation theatres are beginning to look like a scene from a science fiction movie—loaded with large arrays of gadgets among them the neuro navigation system, ultrasonic surgical aspirator, lasers, high-speed pneumatic drills, micro dopplers and intra-operative electro-physiological monitoring systems

Neuro navigation has enabled computer-assisted neurosurgery with real-time feedback. Intra-operative ultrasound and intra operative MRI are also available in addition to assist the surgeon. Micro Electro Mechanical Systems (MEMS) have spawned a new arena of micro devices and implants.

The knowledge acquired from the progressive research on stem cells promise to resolve several issues that hinder effective therapeutic neuronal transplantation for disorders like Alzheimers, Parkinson’s Disease and brain and spine injuries.

The identification of adult hematopoietic mesenchymal derived stem cells have several unique characteristics and hold the potential to form and regenerate neural cells. This has stirred new hope for several complex neurological diseases, which have been labeled as incurable.

All these innovations mean that the future of neurosurgery is set to be more exciting than ever before. The original concepts and dogmas are rapidly changing; the therapeutic outlook is improving and surgery is becoming minimally invasive and safer. Emerging neural cell transplantation techniques, in the meantime, promise to make the incurable curable in the years to come.

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