AANS Neurosurgeon | Volume 28, Number 4, 2019


Point: Has Technology Helped Advanced Neurosurgery? Yes.

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It is fashionable to complain about technology. As each new technology becomes available and integrates itself in our daily lives, we find new ways to complain about how that technology does not do everything it should and does not do everything it does do perfectly. With our new complaints, we forget what we were complaining about before and we fail to remember that it was our original complaints that prompted the development of the new technology in the first place.

Short-term Memory Loss
Technology in medicine is no different than technology in the rest of our lives. Our use of the electronic medical record (EMR) is a perfect example of this cognitive dissonance. Let’s remember the state of the paper record. Not so long ago, you had to search the entire ward for a patient’s chart just to write a brief consult note. Upon finding the chart, you then had to try to decipher the hieroglyphics of the previous consult physician whose identity was obscure because his or her signature was illegible. Then, if you needed to review some radiographic images during this process, you would have to walk to the radiology department, either the reading room or the file room (invariably whichever room I went to first, the film I wanted was in the other), have someone “pull” the patient’s film folder (and hope the film you wanted to look at was even in the folder) and then find somewhere to hang it so you could physically look at it.  

Today, most of this can be accomplished through the EMR in less time than it took me to type this paragraph. Patient orders can now be placed from any computer with an internet connection. Allergies and drug interactions are automatically screened, and the pharmacist never has to call the physician to ask what the heck he or she wrote. Even prescriptions that were often difficult to read or got lost by the patient before they even got home are now transmitted electronically, directly to the pharmacy. Yet, because occasionally our computer system crashes or runs slowly, we complain that it is useless and long for the pre-EMR days. How soon we forget.

Advancing for the Patient
In neurosurgery, specifically, we have seen dramatic advances in technology that have truly improved our ability to care for our complex and challenging patients. Where resection of a skull base tumor used to be cranial nerve Russian Roulette, now stereotactic radiosurgery turns such treatment into an outpatient procedure. Clipping of a posterior circulation aneurysm was a similarly demanding operation, now coiling a basilar aneurysm can be one of the most straightforward of neuroendovascular procedures. 

Continuing advances in the development of spinal implants and minimally invasive access devices now keep many people out of uncomfortable braces and collars, while getting them home sooner than ever before. Debilitating disorders, such as Parkinson’s disease, intractable epilepsy and incapacitating tremor, can be routinely treated by neurosurgeons with advanced devices that, just a couple of decades ago, were considered experimental. Not only has technology allowed neurosurgery to advance, but also the neurosurgeon’s embrace of new technology has kept our field vibrant and enabled us to fend off challenges from other specialties that might wish to involve themselves in the treatment of traditionally neurosurgical diseases. 

Technology Does Not Replace Education
Obviously, there are some downsides to an over reliance on technology. Some weeks, a day in the outpatient clinic feels like a day in the computer lab, as more time is spent checking boxes on the EMR than talking with or examining patients. As an American Board of Neurological Surgery (ABNS) director, I am often dismayed by oral examination candidates’ inabilities to mark an appropriate incision for a brain tumor resection. Despite having an MRI (which not too long ago was an “advanced technology” in itself), candidates are so accustomed to using a neuronavigation system that the utility of basic skull landmarks has been lost on them. 

While these are certainly problems, they are not  the fault of technology itself. Advances in technology should not be confused with the seemingly inexorable growth in governmental and non-governmental regulation, even though they are often linked. As physicians, we need to remember that our primary duty is to our patients and, just like a pilot who needs to know how to fly the plane when the autopilot goes out, we need to remain ready to optimally manage our patients even when our latest and greatest devices are not functioning optimally. 

To answer the question, has technology helped advance neurosurgery, one only has to perform the thought experiment of thinking what their practice would be like without a few of their favorite devices and then decide if that is the practice they would prefer. While some of my cerebrovascular colleagues might prefer to go back to the days when neuroendovascular therapies were less pervasive, I am prepared to bet that none of them would be willing to give up their operating microscopes. 

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