Future Trends

The trend toward making microneurosurgery less invasive continues with advances in neuronavigation, and neuroendoscopy and refinement of skull base techniques and surgical approaches to minimize brain retraction. Robotics in microneurosurgery seems to be the next wave of technological innovation to minimize the invasiveness of standard techniques. Certainly, they cannot replace surgeons. Their primary use in neurosurgery would be dexterity enhancement with dampening of physiologic tremor. This may then allow one to operate through narrow corridors safely with the use of endoscopes. Surgery using robotic systems has already been applied in many surgical fields such as the Robodoc System (Integrated Surgical Systems, Davis, CA) for hip joint replacement surgery (51), and the da Vinci System (Intuitive Surgical, Sunnyvale, CA) for coronary artery bypass surgery (52). The NeuRobot telecontrolled micromanipulator system currently under development and in preliminary testing seems to be promising in terms of improving accu racy while minimizing invasiveness. This system has been tested on cadavers to open the sylvian fissure and the floor of the third ventricle through a single burr hole working through multiple working channels (53). Whether these technological advances will make a difference in terms of patient outcome remains to be seen.

Despite the controversies surrounding the use of endovascular therapy in neurosurgery, the use of this modality is increasing exponentially. Several centers throughout the world have adopted this modality as the treatment of choice for intracranial aneurysms. The general thinking is that the current concepts and technology are in evolution, and with improvements in coils, embolic materials, microcatheters, and stents, this modality will become the definitive therapy for many neurovascular disorders. Similarly, rapid developments in neuroimaging, stereotactic techniques, and robotic technology are contributing to the improvement of results and expanding the indications for stereotactic radiosurgery.

The future is exciting, with unlimited scope for these new technological advances to enhance patient care. It is important that with such dramatic advances, patient care and outcome be the sole determinant of the treatment paradigm rather than technology.

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