By Armaan Singh
One of the greatest mysteries that humankind faces today lies right above our noses. It is something that we use constantly throughout daily activities and without it, human functioning would be impossible.
The brain.
As medicine has advanced in the past centuries of human history, we still know very little about the brain. It is the central organ of our nervous system that controls functions as integral as breathing, speech, and the processes of organs. The brain is made up of soft matter and contains neurons, which are information messengers that combine to form nerves. Despite these discoveries, we are still in the dark about the brain and many fundamental questions are still unanswered: How does the brain change in disease? How does the brain stimulate the future? What are emotions? The only task as daunting as decoding the brain is operating on it, especially when tumors are present. While fields such as plastic surgery were performed as early as the Gupta dynasty in India and eye surgery dates back to the Middle Ages, brain surgery began with trepanation–the process of drilling holes into the skull. It was not until the modern era when brain surgery was proposed, taking place during the late 19th and early 20th centuries. These operations often included placing electrodes onto the brain for tumor removal. In 1879, William Macewan, a Scottish Surgeon, performed the first successful removal of a brain tumor.
For context, brain tumors are the abnormal growth of brain cells. Brain cancers stand as the least common of all tumors, with only one percent of the general population diagnosed with a brain tumor in their lifetime. When brain tumors are detected, they can be treated in two fashions–chemotherapy and surgery. The most common surgical treatment for brain tumors are craniotomies. In these procedures, a bone flap on the skull is temporarily removed to increase the ease of access to the brain.
While this surgery is often successful, yielding a success rate of 96%, it is undoubtedly intrusive, thus, various neurologists have proposed less intrusive and possibly more efficient methods in tumor removal. Through modern advancements in medicine and neurology, surgeons have sought out methods of brain tumor removal that are minimally invasive while also being effective. One proposed method of this is known as endoscopic or keyhole surgery. In these surgeries, thin tubing enters two small incisions in the skull or through natural openings. This tubing is known as an endoscope, the purpose of which is to transmit video images of the brain and inform the surgeons about the tumor. If a tumor is detected, specialized instruments will remove it through the opening. Along with being minimally invasive, it also yields great benefits as opposed to traditional procedures that include faster recovery time and reduced risk of brain trauma.
Another modern method of tumor removal is laser therapy. Laser Interstitial Thermal Therapy is a proposed treatment of metastatic brain tumors that has recently gained popularity. In these procedures a laser catheter is inserted into an incision of 2 millimeters into the scalp and then heats up the tumor. The laser does this by first converting its light energy into thermal energy via surrounding tissue. The laser emits photons that are absorbed by the tumor cells followed by a release of thermal energy. This results in a variety of processes affecting the cancer cells, one of which is tissue coagulation, or blood clotting, to prevent bleeding. A few more include processes such as cell necrosis, where a cell dies to external trauma, and protein denaturation, or the breakage of weak links in the protein, which ends up compromising its structure. While promising, the surgery is not fully effective, returning a survival time of 11.6 months. While the tried-and-true methods of neurosurgery have produced hopeful results, there is always room to further innovate, and all being well, these proposed technologies may one day become routine.
Citations
What have I learned?
Question: What is a craniotonomy?
Answer: In these procedures, a bone flap on the skull is temporarily removed to increase the ease of access to the brain. While this surgery is often successful, yielding a success rate of 96%, it is undoubtedly intrusive, and various neurologists have proposed less intrusive and possibly more efficient methods in tumor removal.
Question: What is keyhole surgery?
Answer: In these surgeries, thin tubing enters two small incisions in the skull or through natural openings. This tubing is known as an endoscope whose purpose is to transmit video images of the brain and inform the surgeons about the tumor. If a tumor is detected, specialized instruments will remove it through the opening. Along with being minimally invasive it also yields great benefits as opposed to traditional procedures, which include faster recovery time and reduced risk of brain trauma.