The field of Minimally Invasive Neurosurgery utilizes tiny endoscopes, computers, and image guidance devices to help make surgery safer and less traumatic.
Endoscopes are small telescopes that can be introduced into the brain through tiny openings in the skull. Image guidance devices use computers and special preoperative scans such as MRIs to help guide surgeons to the operative target with pin-point precision, enhancing the safety of the procedure. We are fortunate to have an intra-operative MRI scanner and for selected cases we can actually pause during the surgery to image the brain, ensuring that everything is going according to plan.
Endoscopy is helpful in the treatment of a variety of neurosurgical conditions. In some forms of hydrocephalus, or "water on the brain", endoscopy can be used to open up blockages (or loculations) in the ventricles of the brain, allowing the simplification of shunt systems. In other forms of hydrocephalus (obstructive non-communicating hydrocephalus), a procedure called endoscopic third ventriculostomy (ETV) can treat the condition, eliminating the need for a shunt altogether. In this procedure, a small endoscope is introduced through a dime-sized opening in the skull, and a perforation is made under direct vision in the floor of the third ventricle. This allows the cerebrospinal fluid in the ventricles to bypass the obstruction further downstream and circulate normally, thus eliminating the need for implantation of a permanent shunt device.
Endoscopy also enables us to treat other intracranial conditions such as brain malformations, cysts and tumors with minimal invasiveness. The use of small endoscopes with high resolution optics and computer guidance techniques creates minimal trauma to the brain and can promote faster recoveries.
Dr. Alan Cohen has had an active role in the development of the field of endoscopic neurosurgery at an international level. He has designed instruments and operative approaches and has published widely in the field. He has directed numerous courses on Minimally Invasive Neurosurgery sponsored by the American Association of Neurological Surgeons and other organizations. He is Director of the Minimally Invasive Neurosurgery Laboratory at Rainbow.