Neuronavigation and neurophysiological Monitorizacion in neurosurgery

Surgeons are guided during the surgical interventions of our anatomical knowledge, anatomical and pathological preoperative images of each patient as well as our experience in similar cases.

Despite this background, there were certain possibilities of "getting lost" in the surgical field, not reaching the right place where the injury was or of invading important anatomo-functional areas, with the consequent risk of leaving neurological sequelae.

In the last decade it has reached the technical maturity of having navigation systems, both in cranio-encephalic and vertebral-medullary surgery. These essentially consist of a system that positions us in the real surgical field the preoperative image, in 3D and with an error limit of less than 1mm. This system of neuronavagation, similar to GPS systems, has been a huge surgical advance and a drastic reduction of postoperative sequelae, apart from serving as a storage of our experience case by case.

Not all neuronavigation equipment, as with GPS systems, have the same possibilities. The most advanced give the surgeon information not only anatomical (3D reconstruction, contours of the lesion, vascularization ...) but also on the functional zones and communication channels between nerve centers.

What does neurophysiological monitoring mean? what is it for?

Another great advance of this century has been the possibility of controlling in real time, during the surgical intervention, neurological functions such as vision, hearing, mobility and sensitivity, as well as the function of other pairs or cranial nerves (ocular mobility). , sensitivity and mobility of the face or the complex mechanism of swallowing).

This was previously done by keeping the patient awake. What in certain interventions was impossible to carry out. Today it is possible to monitor all these functions under general anesthesia. Except language, in which it is necessary that the patient is awake and collaborating during the surgical intervention.

This neurophysiological monitoring involves a great technological effort and a great professional capacity on the part of the neurophysiologist who is present throughout the surgical intervention. Sometimes there are more than 50 cables between the patient and the monitor picking up and sending signals.

In this way, tumoral or other types of lesions are treated, which must be treated or removed, in a complementary way: anatomical (with the help of the Neuronavigator) and functional (Neurophysiological Monitoring). So we design the safest routes to access the injury and we have control of the possible damages that we could cause if we go beyond the limits of the injury and enter areas of functionally important risk.

What are the advantages of these advances in neurosurgical interventions?

Nowadays, therefore, a new conception of the surgical act is available. In addition to the knowledge and experience of the surgeon, real anatomical and functional data are added, in real time, throughout the surgical time.

This serves as a guide for the neurosurgeon. It makes you more knowledgeable of anatomy (often distorted by the injury) and warns of the risks of producing sequelae, before a major nerve center or pathway is permanently injured.

This is assuming, in fact, that Neurosurgery is becoming the safest surgery that exists, in terms of a lower percentage of producing sequels or irreversible injuries.

And, posing the problem in reverse, it is increasingly inconceivable that injuries are addressed in functionally important brain structures if these means are not available. And it is being seen that, apart from the professional quality of the neurosurgeon, the availability of increasingly sophisticated neurophysiological and neurophysiological monitoring systems is directly related to good results.