Minimally Invasive Neurosurgery (MIS)

Minimally Invasive Neurosurgical (MIS) techniques offer neurosurgeons a great improvement in working conditions to achieve effective neurosurgery and an improved outcome for patient conditions including:

• Brain tumours: Brain Tumours may be Primary or Secondary (metastasized brain tumours)

• Pituitary brain tumours: Brain tumours originating from the pituitary gland

• Intracranial (brain) aneurysms: Bulge or ballooning of a brain blood vessel

• Trigeminal Neuralgia: Trigeminal nerve disorder causing sudden, intense facial pain

• Brain lesions: Abnormal brain tissue

• Minimally Invasive Spine Surgery (MISS): Keyhole or minimal access spine surgery

Minimally Invasive Neurosurgery (MIS) is not just the sole use of a microscope during a conventional neurosurgical exploration. It is an entirely new surgical discipline and concept requiring the use of a mobile counter-balanced operating microscope, and necessitating mastery of indirect eye-hand interaction which can only be acquired in a specially equipped laboratory.

Minimally Invasive Surgery (MIS) has two main components:

1. Special equipment:

• Counter-balanced mobile operating microscope equipped with T.V. camera and monitors to enhance and promote team work in the operating room between surgeon, neuroanesthesiologist, nurses, and technicians.

• Bipolar coagulators and bipolar forceps of different lengths and tip size. Also “Isocool” (J&J product) bipolar tips that need minimal cleaning due to patented internal thermodynamic countercurrent cooling mechanism.

• Pressure regulated suction apparatus and suction tubes in different lengths and diameters.

• Bayonet-shaped surgical instruments in different lengths and tip sizes and malleable microinstruments.

• Microsutures and special needle holders.

• Self-retaining "protective" brain retractors.

• Hydraulic chair and adjustable arm rest for the surgeon.

• Magnified Loupes (glasses for general Neurosurgery, peripheral nerve surgery and spinal surgery outside the dura (spinal cord and root covering). Also used with a headlight for optimal lighting.

2. Special surgical techniques requiring laboratory training:

• Enhanced eye-hand interaction working under conditions of indirect vision with the operating microscope.

• Delicate manipulation with microinstruments during dissection, clipping, coagulating, neurovascular repair, and grafting.

• Tactics to operating within a key-hole approach performing the procedures as mentioned above; but, under more difficult conditions, for example plastic boxes of different heights (5-12 cm) and with narrow openings cm diameter) simulate deep narrow approaches within and around the brain. RACS workshops and accredited Microneurosurgical courses. Also Da Vinci robotic surgical techniques used in Urology.

• Delicate and controlled manipulations within the confines of a small gap and using a self-retaining protective brain retractor.

• Training the use and applications of the bipolar coagulator and microsuction equipment.

• Training to develop expertise and comfort using high-speed surgical drills. i.e. Midas Rex (Medtronic) drill workshops accredited world-wide.