Advances In Stereotactic And Functional Neurosurgery 12

Neurosurgery o/the Future: Computers and Robots in Clinical Neurosurgical Practice and in Training - a Philosophical Journey into the Future Many present day neurosurgeons believe that they already obtain good results in operative surgery with the benefit of the operating microscope and other aids which have become available in the last three decades and that the introduction of computers and robots to the operating theatre is superfluous. However, it is clear from analogy with the function of the airline pilot, another profession where there are great demands on manual skill and on spatial awareness, that these devices do have much to offer neurosurgery. Classical neurosurgery, in the time of Cushing, Dandy and Scarff, was based on a three dimensional picture of the patient's brain formed in the surgeon's mind and often illustrated in elegant drawings. Such pictures were based on neuroradiological studies by pneumoencephalography, ventriculography or by angiography. Generally these stud ies showed the presence and position of a lesion by displacement of normal brain structures and the picture was built up by interference. This was then converted by the experienced neurosurgeon into a plan for the craniotomy site and the trajectory of the surgical approach. Once the brain was exposed further pre-operative information was obtained by visual inspection and by palpation with the brain needle. These classical forms ofneuroradiology have largely been superseded by computerised tomography and by magnetic resonance imaging.

These proceedings from the Xth Congress of the European Society for Stereotactic and Functional Neurosurgery in Stockholm reflect the growing interest in these fields of neurosurgery. It is the most extensive volume in this series of publications and it contains a large number of original articles pertaining to the most recent advances in stereotactic and functional neurosurgery. Not long ago stereotactic neurosurgery was considered an esoteric sub speciality practised only by those involved in treating movement disorders and pain. In the last decade we have witnessed the incorporation of stereotactic methodology in the management of common neurosurgical diseases, and the stereotactic technique is now practised in all major neurosurgical centers. As with other surgical techniques and tools, however, the utilization of stereotactic methods requires special knowledge and training. This book comprises articles which give insight into new stereotactic applications and technology. For example, the usage of stereotaxis without a frame and the so-called navigator systems in open tumor surgery is dealt with in two papers. The introduction and development of radiosurgery is closely linked to the advancement of stereotactic technique. Radiosurgical treatment of tumors and cerebrovascular diseases has been one of major achievements in modern neurosurgery. This publication contains several original reports illustrating the efficacy of radiosurgery in problematic neurosurgical diseases.

The book gives the most up-to-date information for the expanding field of stereotactic and functional neurosurgery from European and international experts. The newest developments in neural transplantation and stereotactic irradiation are included together with the reports on extensive trials of analgesic surgery and new techniques used in the treatment of a variety of functional disorders.

The last ten years has witnessed a resurgence of interest in stereotactic surgery although this has been mainly in the field of the comparatively simple stereotactic biopsy of intracranial tumours. There is also evidence of a returning interest in functional neurosurgery other than pain which has always sustained high levels of endeavour. The present work comprises selected papers from a much larger group of interesting and important communications to the European Society for Stereotactic and Functional Neurosurgery. They represent modern views on a wide variety of stereotactic surgical topics from internationally acclaimed experts in this field. The neurosurgeon who has little or no acquaintance with this fruitful sub-specialty will be surprised to find very broad applications of the technique which is gradually replacing many con ventional neurosurgical procedures. This is particularly evident in the papers on tumours but there is also a section on the treatment of vascular disease which marks an extension of neurosurgical practice. The Society has always regarded technical advances as important and some of the most recent devel opments appear in this book. Finally, an exciting new development of neural transplantation marks the beginning of what may be an important part of neurological surgery in the future.

The increasing importance of stereotactic surgery in the management of common neurological conditions is illustrated by the broad applications of stereotactic techniques described in this book. International authorities present their most up-to-date experience in the fields of movement disorder, tumours, epilepsy, and pain and spasticity. The integration of modern imaging techniques with stereotactic instrumentation is a particular feature. The book provides the most modern description of the techniques and applications of an expanding field of neurosurgery.