Neuronavigation and Fluorescence-Guided Brain Tumour Surgery

We do endoscopic third ventriculostomy in paediatric congenital hydrocephalus, but success is slightly lower at a young age — around 70-80%. A programmable shunt has a 95% success rate, but shunt revision and infection are other factors to weigh; endoscopic third ventriculostomy is a better choice when it succeeds, since the chances of recurrence problems afterward are very low.

We keep the patient for three or four days; the pain is usually gone right after surgery. We continue medication for one month afterward and then stop it. We mobilise the patient to walk from the next day, and they generally do very well. We do a post-operative CT scan to check for any bleeding or collection, but results are close to perfect.

The screws used in spine surgery are not absorbable — they remain in place lifelong. Financially, robotic-assisted spine surgery costs about $1,000 to $2,000 extra on top of a normal spine surgery of around $7,000, but the advantage is that screw misplacement drops to less than 1%, which is significant because a single misplaced screw can undermine the whole surgery — so while it adds cost, it also adds real value to the outcome.

Absolute contraindications include cardiac problems, any bleeding or coagulation disorders, or severe infection in the body. If a patient — for example with trigeminal neuralgia — is responding well to medication at a controllable dose, we will not operate; surgery is offered when the patient's pain is not relieved despite medical management.

There can be anaesthesia-related complications. On the surgical side, we can get a haematoma in the cerebellum, sometimes bleeding, sometimes infection, or damage to the nerves — though our infection rate is very low. One patient developed chemical meningitis leading to hydrocephalus and needed a shunt, but the rest did very well. Initially some patients complained of partial hearing loss from traction on the eighth nerve; now we use minimal traction, so results are good and complications are minimal.

Neuronavigation uses a patient's stored preoperative brain imaging to guide the surgeon during the operation, allowing a smaller craniotomy while still planning and completely removing the marked tumour.

A yellow dye is given before the operation, and under a yellow filter on the operating microscope the tumour tissue changes colour, making it far easier to identify and completely remove.

They matter most when a tumour sits in an eloquent area controlling speech or movement, where removing as much tumour as possible without damaging surrounding function is the goal.