28/11/2025
and – Language of development and modernization in
Being minimal invasive is human. It makes surgeon and the patient more comfortable and gives more satisfactory results of the procedures. Although it may not be possible in every case but it’s always an agenda in every surgeon’s mind.
In Neurosurgery technology came to our help with stereotactic frame. With its help precise trajectory to the lesion and correspondingly from the scalp incision craniotomy and further path to the lesion was made with minimal trauma to the adjacent normal tissues.
I recent decades, endoscopes have made the purpose of minimal invasive or keyhole neurosurgery more feasible. Better Magnification with wider angle panoramic view has given the advantage over the microscope. In areas like skull base and Intraventricular procedures endoscope and Neuroendoscope are the vital instruments without which surgery becomes very difficult if not impossible.
Potential advantages of keyhole brain & skull base and spine surgery:
Smaller incisions and bony openings (or no incision is performed through the nostrils – endonasal)
Less exposure to normal brain and para spinal structures
No use of brain retraction or deep retractors of spine with less manipulation of the brain and para spinal tissues
Less pain and lower need for narcotics
Rapid recovery, mobilization, and return to normal activities
Discharge from hospital typically within 1 to 2 days post-surgery
These approaches are technically demanding, require specialized instrumentation, significant surgical expertise and are not appropriate for all tumors.
Procedures, technologies and instruments -
Stereotactic frame – with help of frame
And preoperative CT or MRI scan, calculation of the coordinates for the decided target trajectory is made and surgical steps are performed.
Limited number of targets and trajectories are the limitations and frame is cumbersome.
Neuronavigation – GPS for the Brain, with help of CT or MRI scan data, cameras and computerized analysis,
A three dimensional projection of the trajectories is provided. Instruments can be navigated through the surgical field under computerized visuals. Though intra operative MRI or CT scan is not available, a real-time location with reference to the pre-operative pictures is possible.
Neurosurgery suite – Enhances the surgical precision with availability of all the instruments including MRI with in the operation room in addition to other instruments. Intraoperative changes and residual lesions ca be seen with accuracy.
Endoscope – Helps in minimal invasive procedures specially skull base and Pituitary surgery. In case of Trans nasal procedures no incision on the skin is needed.
Conditions treated with endoscopic neurosurgery
Pituitary tumors: Tumors on the pituitary gland
Skull base tumors: Tumors located at the base of the skull
Hydrocephalus: A condition where cerebrospinal fluid builds up in the brain
Intracranial cysts: Cysts located inside the brain, such as arachnoid cysts
Intraventricular lesions: Abnormal growths within the brain's ventricles
Spinal lesions: Disorders of the spinal cord
Benefits of endoscopic neurosurgery
Minimally invasive:
Results in smaller incisions or uses natural openings, causing less trauma to surrounding tissues.
Quicker recovery:
Patients often have shorter hospital stays and can return to normal activities more quickly.
Less pain:
Associated with less post-operative pain compared to traditional open surgery.
Reduced scarring:
Leads to less noticeable scarring.
Improved visualization:
Provides enhanced visualization of critical structures, allowing for greater precision.
Neuroendoscope – with water interface, Neuroendoscope and Spine endoscope makes per operative visibility better and helps in precision surgical maneuvers. Endoscopic third Ventriculostomy for hydrocephalus which avoids the need of a shunt tube and other intra ventricular and deep procedures are made amazingly easy.
Minimal invasive spine surgery –
Endoscope in spine Surgery - Surgeries like Discectomy, Laminectomy ad decompression can be done through key hole surgeries.
Minimal invasive spine fixation and fusion can be done using canulated probes under fluoroscopic guidance with key hole incisions.
Exoscope – is a newer entrant with endoscope and better picture display. It adds the benefit of microscope to the endoscope.
Development and modernization in Neurosurgery has been directly associated and in pace with the development in the optics of microscope ad endoscope. Minimal invasive techniques and technologies have made outcome of the surgical procedures better progressively.
