โ Scribed by Dr. Barton L. Guthrie
No coin nor oath required. For personal study only.
As long as surgical invasion of the nervous system is considered therapeutically justified, there will be efforts to improve surgical technique and outcome. The less the invasiveness, the faster and better the healing. Surgical "invasion" consists of:
Operative approach is crucial in cranial surgery. Many cerebral lesions are considered inoperable, not because of their intrinsic pathologic nature, but because of the destructive surgical approach required to reach the lesion. For example, technically, a thalamic metastatic tumor is as "removable" as is a right frontal metastatic tumor. However, the approach through normal brain to the thalamic tumor can result in significant cerebral injury. A similar principle applies to many other lesions such as arteriovenous malformations (AVMs). Therefore, many cerebral lesions are rendered "inoperable," not because of difficult intrinsic pathology, but because of their location. Additionally, if the surgeon not only has to "approach" the lesion, but find it, the potential hazard is greater.
Once the surgeon has obtained the lesion (i.e., completed the approach), the pathology itself must be dealt with. This generally entails exposing the lesion in question and removing/manipulating tissue (such as a tumor) or inserting devices (such as aneurysm clips). Regardless, the principle of least invasiveness is desirable. A minimally invasive approach is worth little if the surgeon cannot deal
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