Advances in Minimally Invasive
Brain and Spine Procedures

Advances in minimally invasive technology have transformed the way surgeons perform many brain and spine procedures. Today, image-guided surgery technology has revolutionized traditional techniques by providing surgeons with a way to navigate through the body using threedimensional images as their guide.

"The brain and spine lend themselves well to minimally invasive surgery because they’re generally fixed structures, says Amos Dare, MD, Director of Neurosurgery at Wellington Regional Medical Center. "We use tubes to reach the surgical site, microscopes or endoscopes to magnify our view and tiny surgical instruments to perform brain and spine procedures."

Dr. Dare joined the medical staff at Wellington Regional Medical Center a year ago. He is one of the few surgeons in the area who performs minimally invasive brain and spine procedures.

Brain Surgery

Because of the complexity of the brain, it is necessary to approach surgery carefully and with extreme planning to minimize the risk to the patient. In the not-so-distant past, neurosurgeons frequently used large skull openings to treat many structural lesions of the brain. These techniques often disturbed normal brain structures.

Stereotactic navigational planning for brain surgery

With the implementation of Medtronic’s StealthStation® TRIA™, an intraoperative stereotactic navigation system, surgeons at Wellington Regional Medical Center are now able to create an exact, detailed plan for surgery -- where the best spot is to make the incision, the optimal path to the targeted area and what critical structures must be avoided.

This technology creates images that allow the neurosurgeon to see the abnormality, such as a brain tumor, and distinguish it from surrounding healthy tissue. An MRI taken of the brain right before surgery is stored in the computer. A constant flow of information helps surgeons make minute adjustments so they can arrive at the destination of pathology in the brain while avoiding exposure and potential injury to normal brain tissue.

"This translates into short and safer surgeries, decreases the size of the patient’s incision and reduces the procedure’s invasiveness," Dr. Dare says. "Overall, patients require shorter hospital stays and can return to their daily routines sooner."

• Stereotactic radiation therapy.Some brain diseases, such as tumors and arteriovenous malformations (AVM), may require treatment with radiation, with or without surgery. The navigation system can also be applied to radiation treatment, allowing precise delivery of radiation to a target in the brain. Again, a roadmap of the brain is stored in the computer, and all the treatment planning is performed even before the patient arrives at the center. In the past, such precise treatment was not possible. Stereotactic radiation therapy is a novel collaborative effort between neurosurgeons and radiation oncologists to treat diseases in a minimally invasive fashion using this advanced technology.




• Tiny coils are used too fill aneurysms, prevent blood flow to them and reduce the chance for rupture.

  Endovascular treatments. The same technology used in cardiac catheterization has been adapted to perform some minimally invasive brain surgeries. Aneurysms in the brain are life-threatening because they may be fatal when they rupture. To treat aneurysms, tiny coils are advanced through a catheter placed in the groin to a location in the brain. The coil material fills the aneurysm, prevents blood flow to it and reduces the chance for rupture. Similar technology can be used to reopen blockages of the carotid artery in the neck. Again, this is similar to cardiac angioplasty, which is a treatment for blocked heart vessels. Commonly, a cylindrical mesh known as a stent is passed from the groin to the neck and deployed there to keep the vessel open.



• Neuroendoscopy. Similar to what orthopedic surgeons do when they perform arthroscopic surgery of the knee, the neurosurgeon uses the neuroendoscope to enter the ventricles of the brain without causing trauma, either for diagnostic purposes or for treatment of ventricular diseases, such as hydrocephalus, or ventricular tumors. Again, the approach requires a very small incision, a small skull opening, and a short hospital stay.

There are new and better treatments available for patients who suffer from common spine disorders, such as osteoporosis-related spinal fractures or degenerative conditions of the spine.
Surgeons at Wellington Regional Medical Center can often perform minimally invasive procedures to correct common spine disorders, including:

• Osteoporosis-related fractures. Millions of Americans have osteoporosis, a condition that weakens the bones and increases the risk for fractures. Surgeons perform minimally invasive vertebroplasty and kyphoplasty procedures to help relieve pain and disability caused by osteoporosis-related fractures of the spine. During vertebroplasty, a needle is passed through the soft tissue of the back, and bone cement is injected into the fractured vertebra to help stabilize the spine. Kyphoplasty is a modification of vertebroplasty in that a small balloon is inserted and inflated in the fractured bone to help raise the collapsed vertebra to its normal position before the cement is injected.



• Degenerative conditions.There are several types of minimally invasive procedures that can help patients who suffer from painful degenerative diseases of the spine and neck. For example, microdiscectomies help patients with herniated discs that press on the nerves in the back or neck. When performing a microdiscectomy, the surgeon makes small incisions and uses a series of tubes to access the spine and remove the diseased disc. Laminectomies are performed in some patients who have stenosis, or a narrowing of the spinal canal. During this procedure, the surgeon uses the same types of tubes used in microdiscectomies to access the spine. Then, the surgeon removes any bony material that narrows the spinal canal and compresses nerves in the area. Minimally invasive spinal fusions may be an option for patients with diseased discs and unstable spines. Through a small incision, the surgeon can fuse the problem discs together and insert rods and screws that help stabilize the spine.

New Techniques Mean Less Trauma for Patients

Not all patients are candidates for minimally invasive brain and spine procedures. But for the right patients, these newer procedures typically mean smaller incisions, less pain, fewer complications, shorter hospital stays and faster recoveries.

"Minimally invasive procedures are a major improvement in brain and spine surgery," says Dr. Dare. "We’re better able to maintain the stability of these important structures so patients are less likely to face serious problems after their procedures. And, we can offer treatments to some patients -- those who are very ill, frail or obese -- who may not be candidates for conventional surgery."

Amos Dare, MD, is a graduate of the Yale University School of Medicine in New Haven, Conn. After completing a surgical internship and residency in neurological surgery at the New York University Hospitals and the State University Hospital of New York, Buffalo, Dr. Dare received fellowship training at the M.D. Anderson Cancer Center in Houston, Texas. Dr. Dare is a member of the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, the American Medical Association and the Palm Beach County Medical Society. He is affiliated with Palm Beach Brain & Spine, P.A., which is located at 4631 N. Congress Ave., Suite 202, in West Palm Beach. Dr. Dare can be reached at 561-844-0120.

Wellington Regional Medical Center, 10101 Forest Hill Blvd. Wellington, FL 33414 (561) 798-9880