Almost every advancement in modern medicine has been the result of a physician attempting to do things in the future better and safer than he or she has done them in the past.
This concept has perhaps been demonstrated no better than with the practice of modern neurosurgery, which has undergone a dramatic evolution since its origins over 150 years ago.
The ability of today's neurosurgeons to treat a variety of structural lesions affecting the deepest recesses of the brain and spinal cord, while minimizing complications related to manipulating some of the most delicate tissue in the human body, is the result of both insightful pioneering surgeons, as well as dramatic technological advancements that have been applied to our discipline.
Examples include a) the operating microscope - which provides unparalleled visualization for the surgeon, b) endovascular techniques - which allow the treatment of aneurysms and other vascular lesions to be performed through a catheter, avoiding more invasive "open" brain surgery and c) endoscopic surgery - which allows treatment of neurosurgical diseases through more minimally invasive corridors, hastening an individual's recovery.
The most recent modern advancement in the field of neurosurgery has been that of applying a highly concentrated "lethal" dose of radiation very accurately to an area of diseased tissue while minimizing the amount of radiation that surrounding tissues receive just millimeters away - technology referred to as Stereotactic Radiation Therapy, or SRT (also commonly known as Stereotactic Radiosurgery).
The delivering of radiation to tissues with less accurate methods has been around for decades.
When treating a lung or breast tumor, there is relatively little clinical consequence to radiating a few extra inches of normal tissue around the tumor.
This treatment paradigm is unacceptable, however, when treating pathologies of the central nervous system where such techniques can result in significant "collateral damage" of nearby functional neurological tissue, producing new unintended neurological deficits.
This need to accurately and reliably deliver such high doses of radiation to a well-defined but often irregularly shaped tumor with millimeter accuracy to avoid injury to surrounding functional neurological tissue drove the innovations in modern imaging and computing techniques to develop the technological interfaces necessary to accurately target the radiation energy.
The adoption of SRT techniques by all of the sub-specialties of modern neurosurgery has resulted in significant alterations in treatment recommendations to patients with diseases that, in the past, were treated more invasively with "open" brain surgery techniques.
While effective, these techniques generally carry longer post-operative recoveries and carry additional risks associated with traditional surgery (infection, stroke, unintended damage to tissues surrounding the lesion).
This technology has even allowed neurosurgeons to treat some diseases of the brain and spinal cord that, in the past decade, were considered too dangerous to treat.
SRT is truly minimally invasive in its ability to deliver therapeutic energy to an accurately defined target without an incision and has been used over the past two decades to treat a wide variety of pathological neurosurgical conditions.
These include benign and malignant brain tumors, vascular lesions such as arteriovenous malformations, neurodegenerative conditions (e.
g.
Parkinson's disease) and even certain pain syndromes such as trigeminal neuralgia.
Over the last 50 years, a tremendous amount of knowledge has been garnered about targeting techniques, radiation energy dosing and effectiveness with certain lesions to allow SRT to be considered as a valid alternative to open surgery for certain diseases.
With some larger solid and vascular tumors, SRT has been utilized as an adjunctive therapy to "open" surgery and endovascular techniques.
Furthermore, the effectiveness of SRT to provide growth control of certain benign tumors (e.
g.
acoustic neuromas and meningiomas) has caused the neurosurgical community to rethink the best treatment for some of these lesions.
In summary, the development of SRT has benefited neurosurgeons, radiation oncologists and their patients by increasing the options available to treat a variety of benign and malignant pathologies of the central nervous system.
While malignant brain diseases carry a rather cautious prognosis, it is the hope of neurosurgeons and radiation oncologists everywhere that the wider use of SRT technology will allow for the improvement of national 5-year survival averages of around 23%.
This technology has furthered the concept of minimally invasive surgery providing equivalent, and at times, safer therapy for the most intricate of central nervous system diseases.
Although not indicated for every problem, the addition of this technology will undoubtedly be of great benefit to the communities of the world.