Minimally Invasive Surgery
Minimally invasive neurosurgery describes a range of procedures for which doctors use highly specialized instruments to minimize disruption of brain tissue, nerves, and blood vessels.
At Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, minimally invasive surgery is used to treat conditions in adults and children.
The advantages of minimally invasive surgery over traditional open surgery include:
- Smaller incisions and openings
- Smaller scars
- Shorter hospital stays after surgery
- Faster recovery from surgery
- Less cutting of muscles and soft tissues
- Reduced risk of infection and other complications
- Often, less pain after surgery
All these advantages mean that patients can return to their normal lives and activities more quickly—without compromising the safety or effectiveness of treatment.
In addition, some conditions that are not treatable with traditional surgery can now be treated with minimally invasive surgery.
Minimally invasive operations are often performed through incisions and openings much smaller than those created for traditional, open surgical procedures. (Radiosurgery, one technique classified as a kind of minimally invasive surgery, requires no incisions at all.) To perform a procedure through such small incisions requires specialized instruments and technology, including:
- Endoscope: A thin, flexible tube with a light and a camera at the tip. The neurosurgeon inserts the endoscope through a small surgical opening, and the endoscope transmits video images of the soft tissues and other structures inside the body to a large monitor in the operating room.
- Microscopy (High-powered operating microscope): An operating microscope is positioned over the surgical area and provides the neurosurgeon with a highly magnified, brightly illuminated view of the surgical area.
- Fluoroscopy: This technique produces X-ray images in real-time, similar to a video X-ray, and the images are displayed on a monitor in the operating room for the neurosurgeon to see.
- Computer-assisted navigation system: A system that incorporates computer technology and brain imaging to produce three-dimensional (3D) models of the brain. The neurosurgeon uses these models to plan the optimal surgical route and navigate safely to the target area.
The success of minimally invasive surgery relies on the neurosurgeon’s skill and the use of highly sophisticated instruments and technology to aid in the procedure. At Columbia, our neurosurgeons are highly trained in minimally invasive surgery and all the latest advances in this technique. In addition to the instruments and technology described above, they also use:
- Robotic technology: The technology used at Columbia is called Robotized Surgical Assistant (ROSA). ROSA is a computer system that can produce 3-D models of the brain and can also function as a surgical tool. The ROSA system allows our neurosurgeons to utilize its efficiency and extreme precision during certain operations.
- Functional brain mapping: An advanced technique that creates a custom map of the eloquent regions in a patient’s brain. Our neurosurgeons use this map during surgery to preserve the function of these regions.
- Leksell Gamma Knife Icon: This device is the most sophisticated Gamma Knife system available and is housed at the Gamma Knife Center. It uses beams of highly focused gamma rays to treat lesions in the brain without the need for a single incision.
When is Minimally Invasive Surgery performed?
Many procedures at Columbia are performed using minimally invasive techniques, including:
- Brain aneurysm surgery
- Brain tumor surgery
- Cerebrovascular neurosurgery
- Cervical microdiscectomy
- Computer-assisted surgery
- Craniofacial neurosurgery
- Endoscopic neurosurgery
- Endovascular neurosurgery
- Epilepsy surgery
- Extreme lateral interbody fusion (XLIF)
- Image-guided surgery
- Laser ablation
- Lumbar fusion
- Lumbar laminectomy
- Lumbar microdiscectomy
- Pediatric neurosurgery
- Percutaneous pedicle fixation
- Peripheral nerve surgery
- Shunt placement
- Skull base surgery
- Transforaminal interbody lumbar fusion (TLIF)
- Trauma surgery
Some of the minimally invasive techniques used at Columbia can be found only here. For instance, Chiari I malformation surgery is not normally a minimally invasive operation, but at Columbia, the technique our neurosurgeons use is less invasive and equally, if not more, effective than those performed at other top neuroscience centers. Traditional surgery for Chiari I malformation requires the cutting and opening of the protective membrane surrounding the brain, the dura mater. Our neurosurgeons have pioneered a new technique that does not involve cutting or opening the dura mater, resulting in a shorter recovery and reduced risk of infection.