Minimally invasive therapy of the brain

The future of neurosurgery is here, and it is called minimally invasive therapy of the brain. This new discipline merges neurosurgery, neuroradiology, radiation oncology, neurology, medical physics, and computer science into an exciting treatment modality. The superb visualization of the brain provided by magnetic resonance (MR) imaging allows for invasive therapy with minimal disruption of the anatomy and preservation of function. As such, it is fitting that this book is edited by a neurosurgeon and a neuroradiologist. Both De Salles and Lufkin, editors of Minimally Invasive Therapy of the Brain, are from the University of California Los Angeles School of Medicine, where much of the pioneering work on interventional MR imaging has been done. Thirty-nine international authorities collaborated on this text to produce 21 chapters. The varied backgrounds of these individuals serve as a testament to the true multidisciplinary nature of minimally invasive therapy of the brain. The book contains many high-quality MR images of different brain disorders that help emphasize that imaging is perhaps the single most important aspect of this discipline. Historically, the first minimally invasive procedures were probably related to stereotactic brain biopsies, and these procedures are addressed at the beginning of the book. Although frame stereotactic surgery is still used on a daily basis, interactive positioning devices make real-time localization possible and frameless stereotactic surgery a reality. The next chapter deals with graphics workstations and briefly describes image display and surface and volume rendering as they apply to surgical planning and radiosurgery. A short chapter addresses the requirements of databases for neurointerventional procedures. The chapter on functional MR imaging is limited to cortical activation studies and is followed by a chapter that provides a brief introduction to MR spectroscopy. Modern neuroendovascular therapy is addressed in a chapter that is divided basically into those procedures aimed at reducing blood flow (embolizations and aneurysm obliteration with electrothrombotic detachable coils) and those aimed at improving blood flow (thrombolysis for ischemic disease and angioplasty), The next chapter gives the reader an overview of MR image-guided procedures, including laser, radio frequency, cryoablation, and high-intensity focused ultrasound, that produce thermal lesions capable of necrosing targeted tissues. The chapter on instrumentation for interventional MR imaging of the brain is no more than a brief description of the "open-bore" units, which are commercially produced and available for invasive procedures. The next two chapters describe the clinical applications of laser thermotherapy and radio-frequency ablation in greater detail. One chapter is dedicated to functional image-guided ablation for movement, psychiatric, and pain disorders. Much of what is in this chapter was covered in previous chapters. The next five chapters deal with the use of radiosurgery for treatment of vascular malformations, benign and malignant tumors, and functional disorders. Because radiosurgery is already a mature modality, these chapters contain strong data promoting its use. The book ends with three chapters on neuroendoscopy. The first reviews instrumentation, the second deals with stereotacfic and interactive image-guided neuroendoscopy, and the last is on ventricular endoscopy. Certainly, this book will not teach anyone how to do any of the procedures discussed. It does, however, make for fascinating and thought-provoking reading. Minimally invasive therapy of the brain is a truly exciting and innovating discipline that seems to herald the most substantial changes in neurosurgery since the Cushing era.