Why minimally invasive surgery works best for brain and spine problems

There’s a prevailing impression amongst both the medical and non-medical community that neurosurgery and spinal surgery is always high risk, extensively invasive, and considered a last resort for patients – for some, leading to years of pain, medical management and associated conditions that could be avoided with a minimally invasive operation.

I deal with tumours and degenerative spinal conditions, and my area of specialisation lies in pituitary tumours. These tumours I treat, though often benign, can cause an awful lot of trouble because they place pressure on the nerves in the brain that control most of your senses – in the case of pituitary tumours, they are tricky to reach and they often cause progressively deteriorating vision. However, the optic nerves are quite good at recovering, and when the tumour is removed, you frequently see a substantial improvement in vision in patients. A surgery well worth doing, without delay.

But how to reach these tricky locations in a way that limits risk? My particular interest is in endoscopic skull base surgery, using minimally invasive techniques. This involves entering the brain by going up through the nose and drilling out of the back of the sinuses to enter the skeleton below. Endoscopy avoids all the complications that come from having to open up the skull vault and carry out brain retraction. There is less risk with minimally invasive surgery. You can achieve the same or, in some cases, a more impressive removal of the tumour because you can get directly to the tumour.

For the patient, the benefits go even further: they have a faster post-surgery recovery, less time in hospital, and no six month driving restriction - usually when you have any type of operation on your brain, you are unable to drive for six months because of the risk of epilepsy. However, when you operate underneath the brain, there is no risk of epilepsy so patients are not banned from driving at all. For a lot of patients, this makes a big difference.

When it comes to degenerative spinal disease, general wear and tear in the spine can cause damage that results in nerve or spinal cord compression. For a lot of patients, this pain and degeneration can go on for a long time until surgery is considered as a ‘last resort’ – with the risks and benefits weighed against traditional techniques rather than modern, minimally invasive approaches. This leads to pain like sciatica, or you can experience the upper body equivalent down your arm, known as brachialgia. Spinal cord compression leads to progressive weakness, numbness and people can find they have trouble feeding themselves – and can even ending up needing a wheelchair. This type of surgery is about relieving symptoms and stopping the damage that is happening to the spinal cord. In that situation, you are mainly halting the progression, as once the spinal cord has been damaged, it doesn’t improve much. That’s why it is terribly important that those patients have this surgery before they become disabled.

There are a variety of ways of carrying out decompression on the nerves that are not as invasive as they once were, and my particular interest is in doing cervical discectomy and disc replacement. This is where a small metal joint replaces the function of the cervical disc in the neck. This is very good at restoring normal neck movements and neck alignment, and it also helps to avoid the pain that happens with degeneration by getting rid of the pressure on the nerves. It’s a really successful treatment for disc problems in the neck.

Lastly we come to intra-operative image guidance for neurosurgery, also known as neuronavigation - something I was very involved with developing in my research years. It helps you to find your way during surgery when you have a difficult anatomical problem. For example, with pituitary tumours, I always use this for revision surgery. When some of the bone has been removed and there is a build up of scar tissue, it is really useful to be able to interrogate the area and see beyond what’s on the MRI scan. It increases efficiency, you can target biopsies with a needle using neuronavigation, and I also use it to increase accuracy for cases like the placement of screws when instrumenting the spine as part of spinal fusion.

Surgical techniques are advancing every year, and it’s important that patients know that minimally invasive approaches are out there – neuro and spinal surgery no longer need to be the very last resort, or the high risk concern, they once were.

Mr Neil Dorward is a Consultant Neurosurgeon based in London. He has a special interest in neuro-oncology and spinal surgery. Mr Dorward treats a number of conditions including neck and back pain, spinal deformities and brain tumours. He is passionate about the use of minimally invasive techniques in brain and spinal surgery.

Find out more about Mr Neil Dorward: https://finder.hcahealthcare.co.uk/hca/specialist/mr_neil_dorward