THE TREND in surgery today is towards minimally invasive techniques, all geared for patient comfort, lesser blood loss, lesser pain, lesser morbidity, shorter hospital stay, faster recovery, with much less obvious scars. In neurosurgery, a revolutionary endoscopic approach also enhances a surgeon?s ability to reach critical areas of the brain and spine. Minimally invasive surgery must still be ?maximally effective? to attain its major purpose. These procedures are performed by surgeons specially trained in minimally invasive surgery.
Our guest consultant today is Dr. Jeremy D. W. Greenlee, MD, Assistant Professor in Neurosurgery, University of Iowa Hospitals and Clinics, a specialist in minimally invasive neurosurgery, who provided us the answers to these most frequently asked questions below:
What are the goals of minimally invasive surgery?
In minimally invasive neurosurgery, the goals are the same as those of any traditional brain and spine surgery, such as to completely remove a tumor, or relieve pressure on a pinched nerve, or drain an infection, but with the added goals of minimizing post-operative pain, shortening hospital stay, expediting return to normal lifestyle, and achieving excellent cosmetic results.
Are all minimally invasive surgeries the same?
No. For example, in cases of very large blood clots over the surface of the brain from trauma, or large tumors near the surface of the brain, it is not possible to safely and effectively achieve the main goal of the operation (complete removal) through tiny incisions. A long skin incision can still be considered a minimally-invasive surgery if the incision that is used is the shortest possible incision that allows the safe completion of the operation and the least amount of normal tissue disruption, or ?collateral damage? in the process.
What are examples of minimally invasive neurosurgeries?
An example is the removal of tumors at the base of the brain (like Pituitary tumors) by working through the nose (endonasal surgery), therefore avoiding any skin incision at all. Another example is using a small camera (endoscope) for removal of tumors or cysts within the brain using only a tiny (1/2 inch) opening in the skull. Yet another example is operating on the spine through tubular retractor systems so that only 1 ? - inch or shorter incisions are necessary to successfully remove herniated disks, relieve pinched nerves, or fuse vertebrae together.
What other advantages does ?minimally invasive? offer?
The conventional practice requires shaving of hair prior to undergoing brain surgery. Studies have shown that ?shave-less? surgery does not increase a patient?s risk of infection compared to shaving large areas of hair around incisions. Minimally invasive technique use dissolving skin stitches or skin glue to repair the skin incision, so that no stitches or staples have to be taken out once the skin is healed. This lets the patient avoid a trip to the doctor?s office and the slight discomfort of the removal. Another advantage is the use of intraoperative ?Guidance? or ?Navigation? systems which are used by surgeons during procedures to allow the mapping of brain tumors prior to starting surgery. These ?GPS-like? systems can serve as roadmaps to know exactly where tumors sit relative to the scalp and therefore facilitate planning the smallest-possible skin incision and bony opening (craniotomy) necessary for tumor removal. While these are technical considerations, they nonetheless provide better quality of care and comfort for the patient.
Is a minimally invasive surgery more risky than a traditional surgery?
Minimally invasive surgery should not be performed at the expense of achieving the main goal of the procedure and should not add any risk to the patient if done properly. In fact, some minimally invasive surgeries have been shown to REDUCE risks compared to the traditional techniques. Overall, it is much less invasive, as the name suggests.
Are there surgeons that specialize in minimally invasive surgery?
Yes. Some surgeons spend significant time training to learn these special techniques. As with any surgery, experience with the technique is important so that the surgeon?s movements are refined and both the surgeon and assistants are familiar with the special instruments that are needed for minimally invasive procedures.
How can I find a surgeon that performs these procedures?
There are several ways. The best is probably simply asking around your area?family, friends, your regular doctors, nurses in their office, etc. who may have first-hand experience with a particular surgeon. Another way would be to do online, internet searches. Patient support groups can be found for almost any diagnosis. Talking with other patients that have already ?gone through it? can be comforting to newly-diagnosed patients in need of surgery. Keep in mind that is there very good information available on the internet, as well as incorrect information too.
Will my insurance cover minimally invasive surgery?
Insurance coverage should not be any different than for traditional techniques. However, it is always a good idea to discuss the surgery, as well as pre- and post-operative care with your plan provider. In addition, it is recommended, and in most plans required, to get pre-authorization as coverage plans can vary widely.
What other questions should I ask my surgeon?
Patients should always understand the risks and benefits of their medical treatments, whether it is a drug prescribed to them, or a surgery recommended to them. Ask enough questions so that the goals of surgery are clear, expectations are realistic, and possible complications are reviewed. Ask if the surgeon incorporates minimally-invasive techniques, or if a minimally-invasive alternative exists for that procedure.
Is there surgery for Parkinson?s Disease?
One of the recent advances in the management of Parkinson?s Disease is a minimally invasive procedure called Deep Brain Stimulation (DBS). DBS is also being used for other movement disorders such as Essential Tremor and Dystonia. Two electrodes are implanted, one on each side of the brain, and these are connected to a battery pack (like a cardiac pacemaker) placed under the skin in the upper chest. A handheld magnetic device is used to adjust the settings until an optimal balance is achieved to effectively control the tremors. DBS can be a life-changing treatment, transforming a helpless person with such severe tremor that they cannot feed themselves or drink, into an independent, self-sufficient person. This dramatic change occurs within seconds of activating the DBS unit. In some cases, no tremor is even visible! As a result, patients can be more hopeful and positive. While the patient needs to continue taking their medications, DBS is a great solution for now until the final cure for these conditions are found. Currently, DBS is being investigated for possible use in the treatment of depression, obesity, Alzheimer?s and epilepsy. Indeed, the future holds a lot of promise in almost every facet of our life.
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