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Education And Debate

Minimally Invasive Surgery: Neurosurgery

BMJ 1994; 308 doi: (Published 08 January 1994) Cite this as: BMJ 1994;308:126
  1. D G Thomas,
  2. N D Kitchen
  1. Gough-Cooper, Department of Neurological Surgery, Institute of Neurology, London WC1N 3BG
  1. Correspondence to: Dr Kitchen

    The introduction of minimally invasive techniques has greatly improved results for intracranial neurosurgery. Stereotaxy and improved imaging techniques have reduced surgical trauma by allowing surgeons to plan the least damaging route to operative sites and by increasing surgical precision. Stereotaxy has also allowed brain biopsies to be taken from sites such as the brain stem, which were rarely sampled before because free hand biopsy was so dangerous. Brain tumours can now be treated by interstitial radiotherapy - stereotactic insertion of catheters into the lesion for loading of radioactive iodine - or radiosurgery - focusing of intense beams of radiation on lesions without needing surgical incisions. Endoscopic neurosurgery can be used to reach cavities such as the ventricular system or cystic tumours. With interventional neuroradiology fine catheters can be introduced into most vessels in the cranium for embolisation or dilatation. The development of augmentative functional neurosurgery means that movement disorders, epilepsy, and intractable pain can be treated with implanted neurostimulating electrodes. Future developments will probably include frameless stereotaxy, when the rigid attachment of stereotactic apparatus to the patient's head can be dispensed with, and at least partial automation of procedures such brain biopsy. During the last three decades the results of intracranial neurosurgery have improved, largely due to better neuroanaesthesia and the introduction of glucocorticoids to control cerebral oedema and the operating microscope. Most major intracranial neurosurgical procedures, however, have a high potential for morbidity and mortality because of the physical sensitivity and neurological eloquence of the structures involved. In minimally invasive neurosurgery surgical techniques, particularly stereotaxy, have been coupled with improvements in neuroradiological imaging to increase precision and to reduce trauma to normal tissues.


    Stereotaxy was introduced by Horsley and Clarke at the …

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