Neurosurgeries are one of the most challenging among all surgeries undertaken on the human body. The brain, spinal cord, peripheral nerves, and extra-cranial cerebro – vascular system control much of our movement, functioning of the brain and internal organs. Depending on the age of the patient and the condition which requires a surgical procedure, Neurosurgery is broadly divided into Vascular, Stereotactic, Oncological, Skull-base, Spinal, Peripheral-nerve and Paediatric neurosurgery. All of these require a lot of skill and care to manoeuvre through the layers of bone, muscle and nerves to achieve the desired outcome. Hence finding the best neurologist is a key factor in determining the success of the procedure.
Considering the delicate nature of these surgeries, a wide variety of electro-mechanical tools have evolved over a period of time to provide the precision required. More recently, computer-assisted neurosurgery has turned out to be a reliable and popular choice for neurosurgeons worldwide. Here, using a variety of sophisticated imaging tools and devices, including robotic assistants, the surgeon is carefully guided through the surgery, in order to achieve better outcomes. Such procedures, and the technology behind them, are collectively called Neuro-navigation.
Necessity for Neuro-navigation
There are various conditions of the patient which require surgical removal of one or more affected tissue(s), either in the brain, spinal cord or skull base. Such procedures include removal of brain tumours, deep-seated brain lesions, treatment for movement disorders such as Parkinson’s disease and dystonias. Removal of these tissues may affect one or more functional areas of the brain. To ensure minimum damage to the functional areas, hitherto, key-hole surgery and microscopic procedures were the norm.
However, these come with the limitation that the operational area or field is severely limited. For the procedure to be successful, the surgeon must have extraordinary precision and access to data about the precise location of his/her instruments and distance from the concerned tissue.
Neuronavigation helps overcome this limitation. Here, a mathematical model of the concerned tissue and the surgeon’s hands, or more specifically the focal point of his/her instruments,is displayed prominently on a monitor screen, with clear co-ordinates. As and how the surgeon proceeds with the operation, this image is updated in real-time. This way, the surgeon achieves perfect orientation in the operation field,and hence a safe and accurate removal of the concerned tissue. In short, Neuro-navigation is an easy-to-use system that increases efficiency in neuro-surgical procedures.
Also Read: Neurological Physiotherapy
Neuro-navigational Tools and Procedures
Over the years, various technologies have evolved that help achieve precise locating of an affected tissue, technically called functional localization. These include angiography, air ventriculography,Computed tomography scan or CT scan, Magnetic Resonance Imaging or MRI scan, Positron Emission Tomography or PET scan, Magneto-encephalography or MEG, Electrocorticography or ECoG used for real-time functional brain mapping and stereotactic radiosurgery. Neuronavigation involves the use of one or more of these sophisticated imaging technologies along with sophisticated surgical tools to help orient the surgeon with three-dimensional images of the patient’s anatomy before and during surgery.
- Brain tumour resection
- Pituitary surgery
- Awake brain surgery used for treating epilepsy
- Brain biopsy for various conditions such as Parkinson’s disease, Huntington’s disease dementia, Alzheimer’s disease, amyotrophic lateral sclerosis, mitochondria disease, etc
- Neuro-pathology from post-mortem autopsies
With time, Neuronavigation will evolve to incorporate more hi-tech imaging techniques and surgical tools. Neuronavigation in the hands of the best neurologists is indeed a boon for patients of various conditions ranging from epilepsy to brain tumours to movement disorders. Till recently, such procedures were only outside India. State-of-the-art hospitals like Kauvery Hospital, which is at the forefront of healthcare innovation and research, now offer Neuronavigation-assisted surgeries in India, at a fraction of the cost incurred abroad.