Minimal Invasive Neurosurgery
Introduction of highly refined techniques and approaches to the Neurosurgical treatment options of Brain and Spinal diseases are the concept of Minimally Invasive Neurosurgery.
Major advances in Neurological Surgery have occurred over the past 30 years consequent to the development of Microneurosurgical Instrumentation and procedures, the improvement and reliability of diagnostic neuroimaging methods (MRI and CT scanning), and the availability of sophisticated anaesthetic techniques.
Currently we are enjoying the "Next Step" in the evolution of Neurosurgical capabilities with the introduction of Minimally Invasive Neurosurgery techniques. While the operations still require the "Opening" of the Skull (for Brain operations) or the Spinal Canal (for Spine operations), these openings for exposure are much smaller than ever previously contemplated. LIMITED EXPOSURE means limited "Injury" to surrounding tissue. This usually results in the REDUCTION of POST-OPERATIVE PAIN, REDUCTION in the LENGTH of STAY in the HOSPITAL (many operations are done on an out-patient basis), REDUCTION in TIME to RETURN to WORK and REDUCTION in OVERALL COST.
Minimally Invasive INTRACRANIAL Neurosurgery involves the use of an instrument system which uses an ENDOSCOPE. This is an instrument that permits "Visualization" of anatomical structures within the body using a narrow channel that incorporates a brilliant light source together with a sophisticated, miniaturized camera system. The ENDOSCOPE also has "Working" channels through which small, elongated instruments can be placed in order to conduct operations deep within the body.
There are three (3) types of ENDOSCOPIC operations available for Neurosurgical procedures inside the Skull (Brain surgery), as well as inside the Spinal Column.
This is an operation conducted entirely through the Endoscope. All the instruments that are used in the operation are introduced through the small, working channels that are incorporated within the Endoscope. Examples of this type of surgery includes: Anterior Third Ventriculostomy (for Hydrocephalus), Intraventricular operations for removal of Tumors such as Intraventricular Meningioma or a Colloid Cyst and Fenestration/Resection of Intracranial Arachnoid Cysts, among other procedures.
Endoscopic Assisted Surgery
This is an operation conducted using a sophisticated Neurosurgical Operating Microscope for visualization and advanced Microneurosurgical techniques, to surgically manage a disease process. During the operation an Endoscope is introduced into the operative area to permit visualization of structures beyond the range of the operating microscope, such as around corners or "underneath" other deep anatomical structures. The Endoscopic image can be viewed on a television monitor, or through a "heads up" display projected to the operating microscope. Examples of this type of Neurosurgical operations include Aneurysm and Skull Base and Brain Tumor surgery.
Endoscopic Directed Surgery
This is an operation that is conducted with the Endoscope as the primary visualization system rather than the Operating Microscope. In these operations, the Endoscope's image is viewed on a television screen with surgical tools being used "OUTSIDE" (that is, beside and around) the Endoscope rather than introducing the instruments through the Endoscope's narrow internal channels. Examples of these Minimally Invasive Microendoscopic INTRACRANIAL Operations include Transsphenoidal Resection of Pituitary Tumors, Skull Base Tumor removal, Microvascular Decompression (MVD) of Cranial Nerves for Trigeminal Neuralgia, Intraventricular Tumors, and Aneurysms.
Minimally Invasive Microendoscopic Spine Operations
The introduction of Minimally Invasive Neurosurgery constitutes a real revolution in the treatment of spine problems. These techniques have become the method of choice for most of our procedures.
The concept of Minimally Invasive Surgery has been used across many areas of surgical disciplines. In the area of Spine Surgery, we believe that this SHOULD MEAN using the smallest aperture retraction systems possible. It is now generally accepted that Posterior (from the back) approaches to the Spine can and should be done in a way that preserves the function of the large muscles that course vertically along either side of the Spinal Column. The older technique (including standard microsurgical procedures) of midline incisions require that these paravertebral muscles be stripped from the spinal bone and held retracted under considerable pressure to allow the surgeon access to the Spinal Canal.
The technology for Minimally Invasive Spine Surgery allows for an incision just off the midline to the side of the pathological process (such as a Herniated Intervertebral Disc and/or Spinal Stenosis [narrowing of the Spinal Canal]). Instead of stripping muscle from bone, the muscle fibres are separated and held retracted by narrow diameter tubes. In point of fact, the diameter of these tubes varies in size from 14 millimeters to over 26 millimeters (one inch). With larger bore retractor tubes more muscle is displaced and potentially injured. We believe that the SMALLEST DIAMETER TUBES SHOULD BE USED. For most routine Lumbar and Posterior Cervical Spine Surgery, we utilize 14, 16 and 18 millimeter diameter tubes.
Minimally Invasive Microendoscopic Spine Operations are being conducted for Spinal Cord Tumors, Herniated Intervertebral Disc, Spinal Stenosis, Lateral Recess and/or Foraminal Stenosis, Cauda Equina Claudication and Spondylolisthesis. These Minimally Invasive Techniques allow for operations such as Laminotomy, Laminectomy, Transforaminal Lumbar Interbody Fusion (TLIF) and Placement of Pedicle Screw & Rods for Spinal Instability requiring a Fusion Operation.
Bilateral Laminectomy / A Unilateral Approach
An exciting and revolutionary development in Spine Surgery is the incorporation of advanced techniques within the principles of Minimally Invasive Spine Surgery. For spinal conditions that require both sides (BILATERAL) of the Spinal Canal to be decompressed, we routinely use a UNILATERAL (one-sided) APPROACH. The advantage here is that the spinal muscles are disturbed to a minimal degree and only from one side. The results are a dramatic change from previous operative techniques. This has considerable importance for patients who have severe Spinal Stenosis resulting from Lumbar Facet and Ligamentum Flavum hypertrophy as well as patients suffering from Spinal Cord Tumors.
Early Discharge/Less Pain/Early Return to Work/Less Cost
The result of this technical surgical advance is that our patients (including many of those over 70 years of age) who undergo Minimally Invasive Bilateral Decompressive Laminectomies using a Unilateral Approach are usually out of bed within 4 hours of operation.
Most operations conducted for HERNIATED INTERVERTEBBRAL DISC and/or SPINAL/FORAMENAL STENOSIS (including those requiring Bilateral Decompressive Laminectomy using a Unilateral Approach), are considered to be more routine procedures which can be accomplished through 14, 16 or 18 millimeter diameter tubes. These are the smallest tubes available and cause the least disruption of tissue. For most of our patients this permits them to be treated on an OUT PATIENT, DAY-SURGERY BASIS.
Spine Fusion for Instability
Minimally Invasive Lumbar Spine Fusion operations are now routinely used for these procedures. Our indications for fusion are quite strict and generally are reserved for patients who are symptomatic with demonstrated spinal instability (such as Spondylolisthesis. Although all of these patients are also walking within 4 hours of surgery and most want to go home the same day, we generally prefer that they stay in hospital overnight. This, as well, is a major advance compared to more conventional techniques of "lumbar fusion".
Spinal Cord Tumors
Spinal Cord Tumors are difficult and dangerous problems. With the introduction of Minimally Invasive Spine Surgery techniques we are able to offer improvements in the management of these conditions compared to standard operations for the removal of Spinal Cord Tumors such as Spinal Meningioma, Ependymoma and Neurofibroma.
Minimally Invasive Techniques for Cervical Spine
Cervical Spine operations constitute a significant part of our practice. For those patients with conditions that are amenable to a Minimally Invasive approach, we are pleased to offer this alternative. The conditions that do lend themselves to this technique include Far Lateral Extruded Cervical Intervertebral Discs, Foramenal Stenosis secondary to Cervical Facet Hypertrophy, Spinal Stenosis secondary to Hypertrophic Ligamentum Flavum as well as some Spinal Cord Tumors.