Minimal Access Brain Surgery

Minimally access brain surgery technique uses specialized endoscopes with high resolution video cameras to perform surgery of the brain. This technique can be used to diagnose and treat neurological conditions such as brain tumors, hydrocephalus (fluid buildup in the brain) and movement disorders such as Parkinson’s disease. Traditional brain surgery requires removing a part of the skull to allow access to the brain, in minimal access brain surgery, it usually involves making tiny incisions which allows sutureless procedures to be performed.

Minimal access brain surgery is not more or less risky than traditional surgery when performed with the purpose of making the patient’s life easier and secure. As long as the goal of the procedure is not compromised, it will always offer something extra than as open surgery, such as a better quality of life through faster recovery and less scarring. Plus the prospect of undergoing a surgery which involves only a small opening or no obvious opening is mentally more acceptable to the patients who is already traumatised and scared of an impending brain surgery.

In some cases, minimally access neurosurgeons brings as entirely new facet of treatment to the force, for example, in the treatment of hydrocephalus. Hydrocephalus is a condition frequently encountered in clinical practice, in which there is an abnormal amount of cerebrospinal fluid (CSF) accumulation in the cranium. Traditionally, the treatment of hydrocephalus has been through correcting the overproduction of CSF or diverting the build-up away from the head by surgically placing tubes called shunts inside the brain ventricles and draining it into body cavities. Though effective, shunts are occasionally associated with serious complications, including infection, over-drainage or malfunction. Now using video guidance and no hardware, a surgeon can insert an endoscope through a small hole in the skull into the third ventricle of the brain. There a perforation is made in a membrane to restore normal flow of CSF. Though not all hydrocephalus patients are eligible for approach, approximately 70-80 percent of properly selected patients are successfully treated this way.

Minimally invasive neurosurgery is a young field of just a few decades old. In India, its advent started perhaps in the last 2 decades and neurosurgeons here have whole-heartedly embraced this new technology and are exploring the numerous possibilities it throws up. We perform endoscopic third ventriculostomy (like in the case of hydrocephalus), endoscopic removal of pituitary tumours and other skullbase tumors, endoscopic treatment of intra-ventricular tumours, intraparenchymal and ventricular bleeds etc. Endoscopic neurosurgery continues to evolve with technical contributions from neurosurgeons around the world. With accessibility to real time imaging and advanced image guided navigation system, the neurosurgeons are able to monitor patient’s progress and perform more complicated surgeries with accuracy and improved clinical outcomes.

 Dr Sunil Kutty

(Consultant, Neurosurgeon)

Apollo Hospitals – Navi Mumbai