HI-TECH SURGERY
Dr Deshpande V. Rajakumar
M.Ch
Consultant Neurosurgeon
Wockhardt Hospitals, Bangalore

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Take the case of a young mother whose MRI brain scan showed a tumour pressing on her optic nerve. Standard surgery would have meant her skull being opened and the brain surface lifted to approach the tumour. Instead, she had the tumour removed through her nose with a 2.7 mm endoscope and no scar on her skull.

A software engineer whose speech was slurring found a tumour residing adjacent to the speech area in the brain. Traditional brain surgery methods would have entailed a high risk of permanent speech loss. This tumour was removed under local anaesthesia with the patient awake and singing hymns of the Bhagavad Gita!

These examples of "awake brain surgery" are possible due to the development of MRI scanners and optic technology. Further improvements in technology would mean greater clarity in tissue imaging and visualisation. In the laboratory, more sensitive scanners are giving hitherto unimaginable images. Newer three-dimension endoscopes would mean greater precision and better surgical techniques.

Minimally invasive does not always mean smaller incisions. There are instances where a brain tumour resides in an area surrounded by important "eloquent" areas; the slightest damage to these areas would mean a lasting deficit. How then, is it possible to remove these tumours safely? New techniques of imaging are available, where functional MRI (in which functions of the brain are scanned by giving a task to the patient and the resultant increase in blood flow to the brain is imaged) and tractography (where 'information highways' in the brain are imaged) are combined in a single three-dimension image and these are transferred to the "intraoperative navigation system" to compute a pathway to safely remove the tumour.

Like in the brain, enormous improvements are being made in managing patients with problems of the spine. Endoscopic techniques are being utilised to remove fragments of discs that get displaced into the spine canal and compress the nerve. Spine tumours are removed through keyholes with astounding benefits.

Spine surgery is becoming safer by the day. It is no longer necessary for prolonged bed rest after spine surgery. "Flexible" and "dynamic" spine fixation techniques are being developed to improve long-term outcomes.

Obviously, these cutting-edge technologies are expensive. But two decades ago, we were 30 years behind in technology and application of skill when compared to the west. Today, we are just a few years behind and getting to be at par at a rapid pace. With greater impetus on research and development, we could offer cost-effective solutions to the world at large.

The author is senior consultant neurosurgeon, Wockhardt Hospitals, Bangalore.
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