Neurosurgery Q & A
Dr. Ron Alterman, Chief of the Division of Neurosurgery at BIDMC, talks brains, backs and advancements in nerve repair.
Q: Most people may think of neurosurgery as brain surgery. What other areas of the body do neurosurgeons deal with?
Dr. Alterman: It's true that most people think of neurosurgery as brain surgery, but neurosurgeons deal with disorders of the spine and peripheral nerves. In fact, neurosurgeons have been instrumental in the development of advanced spinal surgery techniques for herniated disks, degenerative spine disease, spinal reconstruction after trauma, and minimally invasive spine surgery. In addition, neurosurgeons have championed and been intimately involved in spinal cord injury research. The same is true of peripheral nerve surgery including carpal tunnel release, ulnar nerve transportation, and nerve repair following injury.
Q: How has neurosurgery changed over the past couple of decades?
Dr. Alterman: There have been so many advances in neurosurgery during the last two decades that it is difficult to pick just one that is "most exciting." Certainly, advances in brain imaging and the development of image-guided navigation in the operating room have revolutionized our surgical approaches. The development of advanced spinal instrumentation is perhaps the most significant advance in terms of the number of patients treated and has impacted the treatment of developmental, degenerative, and tumor-related spinal disorders. However, I think the greatest impact in terms of clinical outcomes have come from the development of endovascular (within the blood vessel) treatments for aneurysms and arteriovenous malformations, deep brain stimulation for the treatment of Parkinson's disease, tremor, and dystonia, and intravenous anesthetics for performing neurosurgery. These three developments have radically changed how we treat these problems, minimized the risk to the brain injury during treatment, and dramatically improved our results.
Q: In what ways are advanced imaging technologies helping neurosurgeons?
Dr. Alterman: Thus far, advanced imaging has provided the neurosurgeon with greater anatomical detail about the tumor or aneurysm that he or she is treating. This allows the surgeon to plan a better surgery with fewer surprises in the operating room. As I've already stated, the merging of these high resolution images to intraoperative navigation systems allows the surgeon to approach and remove the lesion more efficiently, minimizing collateral brain injury. Moreover, by helping the surgeon maintain orientation during the surgery, these systems allow the surgeon to perform more complete resection with less chance for the need to re-operate.
Q: What will be the next big thing in neurosurgery?
Dr. Alterman: That's a tough question and like most prognosticators, I'll probably be wrong. We hope and expect that advances in functional imaging will provide important information about the brain tissue we're operating near, further reducing the risks of brain surgery. In addition, we hope that further functional brain imaging research will reveal regions of the brain that behave abnormally in different disorders and can be targeted for deep brain stimulation therapy. In particular, two ongoing trials of deep brain stimulation for clinical depression may radically change the way this very common and debilitating disorder is treated in the near future. Finally, I think advances in drug delivery to the brain may have a great impact on how we treat neurological disorders in the years to come.
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Posted January 2012