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AANS Neurosurgeon | Volume 28, Number 1, 2019


The Beauty of My Dreams

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The future belongs to those who believe in the beauty of their dreams.

Eleanor Roosevelt

Everyone has a list – those things you cannot live without, the things for which you dream and yearn. Maybe it’s a Jaguar XJ Supercharged, a hike up Kilimanjaro, that well-aged bottle of Chateaux Margaux or just a quiet night alone with a special person. Neurosurgeons heft a disproportionate amount of delayed gratification on the personal side in exchange for our professional rewards. However, over the course of a long career, many neurosurgeons increasingly feel the limitations in what we can offer to many of our patients. Thoughts then turn to dreams of a more beautiful future. Why not explore some of the furthest reaches of that potential that the brightest minds can envision? And so we have.

Here are the first things on my personal wish list for neurosurgeons and neurosurgical patients by the year 2030:

  • Lumbar facet joint replacements: implanted safely via minimal access technique
  • Artificial Intelligence (AI) post-operative guidance for all patients, leading to dramatically improved compliance and outcomes
  • Comprehensive understanding of how best to return to activity/work after neurosurgical intervention (notably spine surgery/injury)
  • Blood test biopsy for all neuro-oncological disease with high potential for early detection and intervention
  • 100 percent prevention of congenital defects of the nervous system
  • Real innovation in the application of functional neurosurgery (beyond simple stimulation) into new areas, such as satiety, psychological disorders and more
  • Resident selection and training streamlined, effective, quantifiable
  • Professionalism, diversity and cultural competence globally implemented
  • Electronic medical records that truly deliver on efficiency, capacity for data analysis and quality

As I muse over the potential “asks” for neurosurgery and our patients, I find that my list could grow indefinitely. Given enough time to contemplate, I could fill pages! Of course, I would desire eradication of pediatric brain tumors. The advances toward a cure for leukemia have been legion, while progress for central nervous systems tumors more modest. Who wouldn’t want to have the capacity to stop the inexorable deterioration of cognition? Of our spines?  The desire for perfect diagnosis and treatment intervention across medicine and surgery is, of course, laudable as well and should be nearly attainable in my lifetime. Where should one draw the line for what one hopes? The answer is that our dreams should know no limits.  Harnessing resources, working collaboratively and intelligently, while reaching for the stars has led to remarkable advances in science, technology and medicine – we have every reason to expect this to continue. Greed, avarice and senseless regulations must not be allowed to block this process. Our population is aging inexorably, this makes finding solutions to these problems ever more challenging, but also more necessary.

Our specialty has a history of leading the way with innovation, courage, research and caring. Sometimes, however, we have allowed our horizons to remain too narrow. For example, the drive to find ever-safer and more effective ways to place spinal instrumentation has value, but fusions will always be a poor surrogate for slowing the progression or reversing the impact of spinal degeneration. On occasion, silos of expertise prevent the optimal exploration of intervention. The arena of stereotactic radiosurgery is just one example in which skull-based surgeons, neurosurgeons, radiation oncologists, radiation physicists and software engineers have not always played well in the sandbox. At times, there appear to be inescapable conflicts that thwart solutions to important questions. Such is the case with resident education and training – where the need to provide an exceptional educational experience, while insuring the highest quality of patient care during and subsequent to supervision can feel impossible to achieve. Like the list of wishes, the litany of challenges is also long and complex. 

I like the dreams of the future better than the history of the past.

Thomas Jefferson

2020: This new decade is coming and seems a perfect time to embrace the future. The AANS Neurosurgeon throws down the gauntlet to neurosurgeons, industry, scientists and beyond.  Think big! Expand the horizon! Help us to make a difference, join together in dreaming a brighter future for our many patients who continue to suffer.

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Dr Manish Joseph Mathew | March 7, 2019 at 11:56 pm

Dear Madam,

A beautiful write up.
Looks like a purpose added into a busy, monotonous life.
I would like to add up “detection, visualisation and repair of faulty neural networks” into the future developments.