Our brain is a very complex organ. The average brain weighs about three pounds and is about 15 centimeters long. The cortex of the brain is the most superficial layer and in many ways is the most important part. Most of the brain cells start in the cortex and then extend through the deeper layers and out through the spinal cord to control all of our functions. The cortex is a series of folds that if stretched out would be about two and a half square feet. This contains billions of nerve cells called neurons. All of these neurons help make us sophisticated beings and more complex than any other organism on earth.
Unfortunately, most diseases that affect our brains occur below the cortical surface in deep areas. Hemorrhages, tumors, infections, etc. can be very deep. Therefore, when they require surgical treatment, neurosurgeons must be very careful accessing them without injuring the surrounding normal parts.
Traditional Surgical Approaches to Brain Lesions
Traditional brain surgery involves making an incision in the skin, making a small hole in the skull and then entering and dissecting through normal brain tissue to access the target. Even with advancements in microscopes and other surgical technique, force is inevitably applied to the surrounding brain causing damage to otherwise normal areas.
Spetzler et al. The quiet revolution: retractorless surgery for complex vascular and skull base lesions. Journal of Neurosurgery. 116:291-300, 2012
Minimally Invasive Brain Surgery
In order to avoid pressure on very sensitive brain areas, small cannulated tubes have been developed. They can very carefully be advanced through the normal brain tissue, gently pushing the normal brain cells to the side and causing minimal damage to the surrounding normal brain tissue. This is an almost identical strategy to minimally invasive spine surgery where the retractor tubes push the muscles to the side. This minimally invasive technique is a spectacular advancement in brain surgery that is likely to limit complications and allow better outcomes in brain surgery.
Do you have questions about this technique or minimally invasive brain surgery? Give us a call at Rocky Mountain Brain & Spine Institute to learn more.
Tubular Retractor Advanced to a Deep Brain Lesion
DTI Scan Showing Important Neurons Completely Surrounding Brain Lesion
DTI Scans Showing Retractor Pushing Billions of Brain Cells Out of the Way
Tractography Scan Showing Brain Lesion
Tractography Scan Showing Retractor Postoperative Scan Showing
Essentially no swelling after surgery