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These are interesting facts, observations, surgical hints and management issues during my short surgical career. The aim of this page is to help neurosurgeons from all over to use this material freely so that they may use this as a teaching aid or neurosurgical lessons. Topics have been randomly selected and are being updated depending on the time available.

Instrumentation and advance gadgetry:

With the advent of high-end sophisticated gadgetry in neurosurgery including robotics, the developed world has somehow lost its focus on developing newer instruments for micro neurosurgery.

To my mind, micro neurosurgery with basic micro neurosurgical instruments and a good operating microscope is the cheapest form of treatment in the developing world. When in a country, where clipping of six aneurysms in a single patient will cost less than Rs. 50,000/-, which is a 1000 USD, one must realize that we as neurosurgeons must continue to strive to develop on micro neurosurgical skills to match all the latest high-end gadgetry that the “developed nations” can provide for its patients.

Unless we do this, our patients will have to seek treatment at exorbitant costs and we shall always be playing as a second fiddle to our Western neurosurgical colleagues. However, if we continue to strive to improve our neurosurgical skills, techniques and instruments, we will be able to successfully not only treat our patients but also in the near future aid our neurosurgical colleagues to rediscover the lost art of micro neurosurgery.

Today, centers in the world use neuronavigation techniques to operate on Gliomas. The margins of resection of the tumor are guided by the navigation tool. I have often observed that some neurosurgeons are more biased towards the neuronavigation aids than to the tumor itself and the surrounding brain. Little appreciation is given to the white fiber tracts and the lie of the brain cells. As a result, the surgical exercise becomes more mechanical, certainly less challenging but “technically safe”.

It may happen that patients with gross tumor resections using the above technique develop
neurological deficits. I believe total excision of a Glioma, particularly Low Grade, using neuronavigation techniques at the cost of functional brain tissue is probably not justified, even though the “LAW” is on the side of the treating doctors (provided all the paper work is in order). The “poor” patient or rather the “rich” but unfortunate patient then requires protracted hospitalization, and help of aggressive physiotherapy and modern rehabilitation techniques.

More notes to follow on Instruments…






 

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