Neurosurgery's Future, From the Students
During our third-year curriculum, my classmates and I are required to spend a week on the neurosurgery service as part of the neurology rotation. To students, neurosurgery represents a field that is constantly pushing the limits of medicine. Neurosurgeons use some of the newest technology and the fanciest gadgets in the operating room, and observing the use of an intra-operative MRI, laser ablation or fluorescent imaging are just some of the ways neurosurgery has embraced new technology. An interesting theme emerges when I talk with my classmates about that week: Despite this impressive array of technology, many see aspects of neurosurgery as remarkably primitive. While the indications and techniques for trephination have certainly changed from the Neolithic period, drainage of a subdural hematoma is still one of the most common neurosurgical procedures.
So where is neurosurgery going? As a medical-student still knee-deep in the world of basic science research, the possibilities appear to be endless. Tumor therapy will certainly be changing with targeted therapies and refinements in brain mapping. As one student hints, big data is revolutionizing the world and it will likely do the same for neurosurgery as large databases are compiled to analyze patient outcomes. Functional neurosurgery is poised to treat patients from fields such as rheumatology, with vagus nerve stimulation already approved for treatment of rheumatoid arthritis (1). Brain implants have allowed monkeys with transected spinal cords to walk (2) and quadriplegics to use their own hands again (3).
Light and magnets are both routinely used in the lab to control precise populations of neurons, and this technology will allow surgeon scientists to better understand phenomena, such as seizure etiology and propagation, psychiatric illness and patterns of behavior critical to survival. Looking further, there is border-line science fiction potential. In the laboratory:
- Monkeys have controlled robotic arms hundreds of miles away with their thoughts;
- Rats have transferred sensory information from one brain to another; and
- “Brain-nets” have been created between groups of primates.
Does this portend the rise of brain-computer interfaces beyond cochlear implants and deep brain stimulation (DBS) for Parkinson’s disease?
Predictions are difficult, and some of these more far-fetched ideas may trigger dystopian images. However, it is clear that neurosurgery is a field with broad potential for growth will probably remain a necessity, limited only by the imaginations of the researchers and surgeons; however, it will continue to be refined. Like much of evolution, change in this field is driven, by many of the same rules that have been present since the early days of neurosurgery.
2. Capogrosso, Marco, et al. A brain–spine interface alleviating gait deficits after spinal cord injury in primates. Nature, 539(7628), 284-288.
3. Bouton, C. E., Shaikhouni, A., Annetta, N. V., Bockbrader, M. A., Friedenberg, D. A., Nielson, D. M., … & Morgan, A. G. (2016). Restoring cortical control of functional movement in a human with quadriplegia. Nature, 533(7602), 247-250.
4. Work from the Nicolelis lab at Duke University (http://www.nicolelislab.net/), just one of many labs working on projects like these.
2017 AANS/CNS Section on Pediatric Neurological Surgery
Nov. 28-Dec. 1, 2017; Houston
2nd Homburg ICP and Hydrocephalus Workshop
Nov. 28-30, 2017; Germany
22nd Instructional Course and 45th Annual Meeting of the Cervical Spine Research Society
Nov. 29, 2017 - Dec. 2, 2017; Hollywood, Fla.
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