By Hospals Team Blog Published on - 12 June - 2021

Neurosurgery in Modern Times

Neuro / Spine

With its inception in the early decades of the 20th century, neurological surgery was accompanied by overwhelmingly high mortality and neurological diseases morbidity. However, with time there has been the intrusion of newer techniques and technologies. Thus, neurological surgery had a massive journey from the early years of the last century to the recent date.

In the second and the third decade, the indirect diagnosis of brain tumors and vascular pathologies was possible. The credit for this goes to the introduction of pneumoencephalography, ventriculography and angiography. Surgeons were restricted to crude and conventional diagnostic and operative techniques, and there was the absence of skilled neuro-anesthesia back at that time. The lack of microsurgical instruments and profound knowledge of the professionals about controlling and maintaining the intracranial pressure during surgery resulted in a hostile atmosphere. Sophistication in delineating brain lesions happened in the early 1970s with the advent of Computed Tomography Scan. To manage the raised intracranial pressure during surgery, surgeons welcomed the cerebrospinal fluid diversion procedures for hydrocephalus.

However, the most profound and extensive leap happened in the 1990s. Both the Magnetic Resonance Imaging (MRI) and the high magnification surgical microscope came into existence aiding humanity in the surgical resection of brain tumors. Side by side, colossal progression took place in neuro-anesthesia techniques and the management of intracranial pressure. All the combined efforts led to surgeons operating on a relaxed brain and safely resectioning the brain tumor and managing the vascular lesions. The surgical microscope enhanced the magnification, which resulted in a better understanding of microsurgical anatomy.

The increased rate of mortality and morbidity was further reduced to an extreme level with radiation treatment and chemotherapy developed in the 1950s and 1960s. They acted as adjuvant therapy to combat the brain tumors. The possibilities of central nervous system infections and brain abscesses are also brought under control with the broad-spectrum antibiotics and steroids. Surgeons had taken recourse to the endovascular procedures to treat vascular diseases in the brain in the two concluding decades of the former century.

The 21st century opened new doors in molecular biology and genetics, combined with the boom in information technology. The advancement of computer technology has hailed newer changes. Several computer-based applications like neuro-imaging, neuro-navigation, intraoperative neuro-monitoring have become a part of standard neurosurgical practice. Medical personas use a 64-slice CT scan having the capacity of 3D imaging to treat vascular reconstructions during aneurysm surgery. Also, this advanced feature aids in brain tumour surgery by providing a profound anatomicopathological demonstration.

The metabolic neuro-imaging assists the surgeons to distinguish the brain tumours from infections and metastasis. The doctors use Intraoperative MRI imaging to resect brain tumours such as pituitary adenomas and gliomas with optimum safety.

Functional neuro-imaging, on the other hand, extends help in studying epilepsy surgery.

For patients suffering from spinal cord injuries and degenerative neurological ailments, the modern technique of neuromodulation with stem cells to restore the function of neurological functionalities is in use in the present state. The results whatsoever are not anything outstanding, yet they come with some rays of hope for the patients.

The further incorporation of stereotaxy has given access to robotics in neurosurgery. However, in neurosurgery, it had been around two decades since robots are being used. Still, the current robotic system's restrictions and limitations have kept the maximum usage of robotics in oblivion from humankind.

Behind the opulent progressions and advancement there lies a challenge for the neurosurgeons hailing from the 21st century. The last century has witnessed some extraordinary and remarkable changes in the domain of neuroscience. So, the present-day neurosurgeons have to assimilate those progressions and then incorporate them into the contemporary paradigms.

The advancement in computer technology is hoped to help the researchers probe deeper into the subject by creating large, central databases of neurological diseases. These central databases will then end up becoming perfect reference models for investigation, therapeutics and research.

Surgeries have evolved to a greater level wherein real-time images can be accessed, thus helping a surgeon maintain accuracy. This can be achieved with the help of Intraoperative image guidance. For pituitary surgery, image guidance navigation technique keeps on enlightening the surgeons with anatomical variations of the sphenoid sinus and relationship of tumours with the carotid arteries. But, the only drawback associated with it is that the equipment comes in a high price range.

Further, the operating room personnel has to undergo rigorous training to use the equipment effectively. With the assistance of the linear accelerators and sophisticated systems providing visualization and guidance, surgeons can perform stereotactic radiosurgery. It can treat primary and metastatic lesions and arteriovenous malfunctions. The surgeons are introduced to effective treatment of radioresistant neoplasms through the linear accelerators and visualization systems.

Furthermore, there have taken remarkable advancement in molecular biology and genetics, which can alter the treatment procedure of a brain tumour or a degenerative neurological disease. With the help of genetic microarray, doctors can easily detect the type of brain tumour. Also, it will suggest the therapies targeting the relevant molecular particles.

Foetal neurosurgery has been conducted in an experimental setting, though it will take some more time to incorporate it into routine clinical practice. Worldwide acceptance is still not achieved. But, if the genetic abnormalities in the utero are detected early enough, it will provide the mothers with a chance to come to some acknowledged decision about the future of their pregnancy.

The 21st century will witness the advantage of nano-technology that would allow the doctors to infuse chemotherapeutic agents directly into the tumour bed. The neuroscience has hailed nano-technology applications such as nanoimaging with nano-particles and quantum dots, nano repair, and nanomanipulation.

The modern-day advancements are walking towards making surgeries minimally invasive. Neurosurgeons have to amalgamate both the IT progressions and advancement in molecular biology and genetics in the current medical scenario. The clinical neurology will keep on making decisions regarding surgery, while with the aid of technology, surgeons can achieve precision, perfection and sophisticated techniques.

Furthermore, a Neurosurgeon will have to collaborate with neurologists, neuroradiologists, and psychologists to treat a patient since many neurological diseases have turned multimodal.