Recent Advances in Neurosurgery

Only about 5%, not more than that. In our setup we have done more than 100 surgeries and have not had to redo any; some patients may have mild symptoms that can be managed with medicine or reassurance, but otherwise the results are good.

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.

Recent advances span minimally invasive spine techniques such as percutaneous and endoscopic discectomy, kyphoplasty and robotic-guided screw placement, alongside endoscopic brain procedures, stereotactic and frameless stereotactic surgery, neuronavigation, fluorescence-guided tumour resection and gamma knife radiosurgery.

The field increasingly relies on endoscopic, minimally invasive and image-guided techniques rather than large open surgery, applied across both spine procedures and brain procedures such as ventricular surgery and tumour resection.

Recognising red flags, such as bladder involvement or gross weakness, and understanding when conservative treatment has run its course is often as important to the outcome as the surgical technique itself, across conditions from disc herniation to trigeminal neuralgia to Parkinson's disease.

The series walks through disc herniation surgery, kyphoplasty, cervical disc replacement, robotic spine surgery, endoscopic brain surgery for hydrocephalus and colloid cysts, stereotactic and neuronavigation techniques, trigeminal neuralgia treatment, gliadel wafer chemotherapy, deep brain stimulation, gamma knife radiosurgery and the cost of neurosurgery.