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clearly delineate between masses, tumor margins and healthy tissues to avoid – with sub-millimetric accuracy.
The anatomy of the spine is already very complex, and during some surgeries, patients are repositioned on the operating table. Among patients whose spinal anatomy is unstable i.e. via trauma or severe scoliosis, any movement can alter spinal anatomy. While the Pre-Op diagnostic scans may have changed, altering the planned route of intervention, as a result of the movement, BrainLab’s intuitive compensation features re- triangulate the coordinates, on the fly, providing updated images for the surgeon’s use. Dr. Herman explains, “The system allows us to navigate in through a much smaller approach, enabling greater precision, less blood loss, fewer complications and faster recovery times.”
As well, during spinal surgeries, screws are routinely placed to fix and stabilize the spine. Freehand insertions risk misplacement. Misplaced screws are biomechanically disadvantageous and increase risks for neurological deficits, vascular damage, continued patient pain, and the need for corrective surgery. The new advances have greatly enhanced the ability to hit internal targets, improving the placement of screws with up to 98% accuracy.
Another form of this technology is Stereotactic Radiosurgery (SRS). It is perhaps the only surgery that doesn’t necessarily involve a scalpel making an incision. SRS allows surgeon(s) to very precisely focus photon beams, in order to deliver a highly- concentrated dose of radiation to a target – such as benign or malignant tumors. The use of Stereotactic Radiosurgery as a first-line or salvage treatment for brain metastases is expanding, due to a number of benefits. SRS is highly precise with low probability of healthy tissue damage, and a high probability of treated lesion control. With
SRS, Dr. Herman would most commonly be collaborating with a radiation Oncologist.
Practicing Medicine in the (Dis) Information Age
In reference to practicing medicine in this explosive moment of rapid technological evolution, with the internet peddling genuine up to date information alongside dated or disinformation, Dr. Herman points to the benefits and drawbacks of patients finding medical information online, “Sometimes Patients come in, and they have been perusing the internet to learn about their surgery and condition, or to seek out new surgical techniques and technologies. My patients are often naturally apprehensive about their medical condition. So they may have heard about minimally invasive surgery. Minimally Invasive, whether for brain or spine surgery, sounds great! But sometimes it isn’t the right operation.
I might not have good news to share, or I might have to reassure patients that new developments in Neurosurgery offer better treatment alternatives than what older or flawed web postings convey.
‘We use minimally invasive surgical methods when we can; we have the great new equipment and skillsets, but it’s not always going to give patients the treatment they need. Sometimes the open operation is the safest and best approach for the patient.
‘It’s all about outcomes and treating every patient as an individual, whether it’s being able to walk around the yard, walk around the house, or just spending time with family at home; Whether it’s being able to go skiing or surfing again – I always have to ask myself if doing the surgery will make a difference in the quality of life for that patient while meeting that patient’s goals. Each surgery, each patient, is different. The most important thing to me is that I want patients to feel good about the choice and outcome of their surgery.”
An important thing for patients to understand is that these enhanced technologies are companion tools for surgeons; they do not replace the human physician or the clinical discernment that comes from years of focused and specialized training.
Nor do Stereotactic systems or surgical robotic tools perform actions independently, beyond computer
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