Foundations of Neurological Surgery – serie

In children, the central nervous system tumors complished through advances in the three main are exceeded in incidence only by leukemia and antineoplastic therapeutic modalities-surgery, are more common than any of the other malig- radiation therapy, and chemotherapy. Improve- nancies of childhood. Childhood central nervous ments in neurosurgical technique concomitant system tumors encompass a range of histo- with improvements in anesthesia and periopera- logic varieties from the histologically benign- tive supportive care have resulted in decreased appearing pilocytic astrocytoma to the extremely morbidity and mortality from neurosurgical malignant-appearing glioblastoma multiforme procedures together with an increased likelihood of accomplishing a gross total resection of and the undifferentiated primitive neuroecto- dermal tumors. Similarly, the biologic behavior tumor. Radiotherapy has evolved from using orthovoltage (200-250 KV) equipment to of childhood brain tumors varies not only ac- cording to histology but also with location of supervoltage equipment with much-improved the tumor and age.Unlike primary central nerv- penetration, thus allowing for the administra- ous system tumors in adults, many varieties of tion of accurate homogeneous high doses to childhood brain tumors have the propensity to large volumes without significant effects on the disseminate via the cerebrospinal fluid path- overlying skin and soft tissues. Preliminary data ways.

Developments in the field of instrumentation of innovative instrumentation. Although laser applications have permeated nearly every aspect are among the major contributions to human advancement. The history of surgery has seen of surgical therapy, the expectations have fre­ many revolutionary developments cause quantum quently been unrealistic and the evaluation of leaps in progress. Electrocautery, the anesthesia technological development has always been machine, computed axial tomography, and the painfully slow. The properties of vaporization, surgical microscope are all revolutionary in­ coagulation, and cutting unified in an invisible struments that have irrevocably changed the shaft of light have enabled the neurosurgeon to direction of neurological surgery. vaporize inaccessible tumors of brain and spinal In the early stages of application, there are cord, harness recalcitrant bleeding sites, and cut always detractors and valid controversy concern­ through the most formidable calcified tumors. ing the value of a new instrument. Some will The application of this new energy form in remember those who argued that the magnifica­ tandem with the surgical microscope has, in my tion and illumination provided by the micro­ opinion, extended the scope of all aspects of scope were not valuable to the skilled surgeon neurosurgery. We have much more work to do. and would prolong the operative time and in­ lt is necessary to document improved results and crease infection rates. Others may recall that demand technological advances and safe inno­ Cushing was told to abandon the blood pressure vations.

In children, the central nervous system tumors complished through advances in the three main are exceeded in incidence only by leukemia and antineoplastic therapeutic modalities-surgery, are more common than any of the other malig- radiation therapy, and chemotherapy. Improve- nancies of childhood. Childhood central nervous ments in neurosurgical technique concomitant system tumors encompass a range of histo- with improvements in anesthesia and periopera- logic varieties from the histologically benign- tive supportive care have resulted in decreased appearing pilocytic astrocytoma to the extremely morbidity and mortality from neurosurgical malignant-appearing glioblastoma multiforme procedures together with an increased likelihood of accomplishing a gross total resection of and the undifferentiated primitive neuroecto- dermal tumors. Similarly, the biologic behavior tumor. Radiotherapy has evolved from using orthovoltage (200-250 KV) equipment to of childhood brain tumors varies not only ac- cording to histology but also with location of supervoltage equipment with much-improved the tumor and age.Unlike primary central nerv- penetration, thus allowing for the administra- ous system tumors in adults, many varieties of tion of accurate homogeneous high doses to childhood brain tumors have the propensity to large volumes without significant effects on the disseminate via the cerebrospinal fluid path- overlying skin and soft tissues. Preliminary data ways.

Some will The application of this new energy form in remember those who argued that the magnifica­ tandem with the surgical microscope has, in my tion and illumination provided by the micro­ opinion, extended the scope of all aspects of scope were not valuable to the skilled surgeon neurosurgery.