MINIMALLY INVASIVE NEUROSURGERY

Background: The philosophy and practice of minimally invasive surgery have fundamentally altered the practice of general and gynaecological surgery, and are currently transforming the practice of neurosurgery. The goal of minimally invasive surgery is to reduce tissue disruption and thus morbidity. This is a review of the development, applications, and benefits of minimally invasive neurosurgery, and its wider surgic al implications. Methods: A synthesis of the literature is presented. Results: Interactive computer imaging with frame-based and frameless s tereotaxy, ultrasonographic and endoscopic techniques are increasingly being used independently and in combination in order to execute minim ally invasive approaches and to navigate a safe path within the craniu m or spine. Interaction using an interlinking stereotactic instrument or rebut between the surgeon, a graphic interface (such as a computer workstation) and the patient, enables precise planning and execution o f surgery with exact correspondence of imaging data and the living pat hology. The direct influence of virtual reality, cybernetics, robotics , and telepresence will further revolutionize the practice of neurosur gery and will impact increasingly on other surgical disciplines. Safet y and precision are further enhanced by intra-operative physiological monitoring techniques. Interventional neuroradiology and stereotactic radiosurgery add further dimensions to the minimally invasive approach and may not only diminish the need for open surgery, but in selected cases obviate the need altogether. Conclusions: Minimally invasive neu rosurgery is a major force in contemporary neurosurgery and many of th e current neurosurgical applications will have far-reaching effects on the practice of surgery in general.