Innovation In Neurosurgery Research Articles

What is the most important innovation in neurosurgical practice that will emerge in the next 10 years?

Brain computer interfaces BCIs are automated neurostimulators that analyse brain signals and translate them into output. They aim to allow modulation of neurological functioning at cellular and network levels without the need for clinician-performed adjustments. BCIs are beginning to progress from the research and development phase to their introduction into clinical neurosurgery. Some anticipated applications include advanced treatment of cerebral palsy and stroke, aiming to restore function to these patients. In time, they will become one of the most significant innovations in neurosurgery. 
 Provided here is a review of BCI research to date and their implementation into clinical neuroscience, aiming to highlight the importance of BCIs as a developing treatment modality in neurosurgery in the next decade. 
 A review of the literature was performed using Pubmed as the primary database. BCI applications, recent technological advancements and current challenges facing these devices were reviewed. Trends in research and development were considered and are discussed. It was found that significant developments have been made in manufacturing BCIs that can interpret cortical processes with adequate spatial and temporal resolution. It was shown that the number of procedures to implant neuromodulators taking place in the UK each year is increasing, with more funding provided for BCI research each year. Further to this, a review of publication data found that neuromodulation devices placed among the top new patent categories in neurosurgery in recent years, a large portion of which were BCIs. These results highlight the continually growing interest in BCI research and their application in neurosurgery. 
 In conclusion, BCIs will become an increasingly important area of innovation in neurosurgery. Advances in translational neuroscience, imaging technologies and signal analysis will provide clearer insights into disease processes, allowing increasingly complex devices to address current limitations in the treatment of these conditions.

Innovations in neurosurgery - a novel machine learning predictive model for lumbar disc reherniation following microsurgical discectomy

Innovations in neurosurgery - a novel machine learning predictive model for lumbar disc reherniation following microsurgical discectomy

Innovation in Neurosurgery: Lessons Learned, Obstacles, and Potential Funding Sources

Innovation is central to neurosurgery and has dramatically increased over the last twenty years. Although the specialty innovates as a whole, only 3-4.7% of practicing neurosurgeons hold patents. Various roadblocks to innovation impede this process such as lack of understanding, increasing regulatory complexity, and lack of funding. Newly emerging technologies allow us to understand how to innovate and how to learn from other medical specialties. By further understanding the process of innovation, and the funding that supports it, Neurosurgery can continue to hold innovation as one of its's central tenets.

Seventy-five years of neurosurgery residency training at The Mount Sinai Hospital.

The Department of Neurosurgery's residency program at The Mount Sinai Hospital was founded in 1946. The department has its origins in 1914 as a division of general surgery, with Charles Elsberg at the helm. Neurosurgery then became a separate department in 1932 under the leadership of Ira Cohen. Dr. Cohen oversaw the creation of the neurosurgery residency training program 75 years ago. Since its inception, the residency program has graduated 120 residents. For more than 100 years, The Mount Sinai Hospital has been a site of clinical excellence, groundbreaking research, and technological innovation in neurosurgery. Currently, the Department of Neurosurgery has 39 clinical faculty members, performs more than 5300 surgeries and endovascular procedures annually, and is in the top 25 neurosurgical departments for NIH funding.

Engineering and Innovations in Neurosurgery

Introduction: Modern technology engineered and developed with artificial intelligence have significantly improved the nature of diagnosis and treatment of patients. Healthcare facility has changed significantly in the past few decades because of technological developments. Neurosurgery has been able to practise and enjoy a lot of technologically advanced tools in the past few decades. In context of Nepal, technologically sophisticated devices and tools ranging from neuro navigation, high speed cutting drills, intra operative neuro monitoring, deep brain stimulation, to high resolution magnetic resonance imaging are already introduced. In this paper, the literature review on currently available technologies used in neurosurgery, their significance in delivering a better health care and their usage in Nepal has been discussed.

Innovation in Neurosurgery: The Concept of Cognitive Mapping

In recent years, advances in cortical-subcortical mapping, intraoperative neurophysiology, and neuropsychology have increased the ability to remove intrinsic brain tumors, expanding indications and maximizing the extent of resection. This has provided a significant improvement in progression-free survival, time of malignant transformation (in low-grade gliomas), and overall survival. Although current techniques enable preservation of language and motor functions during surgery, the maintenance of a complex set of functions defined with the term cognition is not always achievable. Cognition is defined as every neural process underlying a high human function and includes motor haptic and visuospatial functions, memory, social interactions, empathy, and emotions. In this regard, an extensive preoperative and postoperative neuropsychological evaluation is strongly suggested to assess cognitive impairment due to tumor growth, to assess surgical result, and to plan cognitive rehabilitation. This article discusses the main recent innovations introduced for cognitive mapping with the aim to preserve cognitive functions, which are essential to maintain a high quality of life.

Fedor Krause (1857-1937) and His Innovations in Neurosurgery.

Although Ernst von Bergmann (1837-1907) is considered the father of neurosurgery in Germany, Fedor Krause (1857-1937) should be considered as its main founder. He was principally a general surgeon but he had a special interest in neurosurgery, a field in which he introduced many new techniques. He also fabricated innovative surgical methods for the treatment of patients with epilepsy.

Oversight and Ethical Regulation of Conflicts of Interest in Neurosurgery in the United States.

Developmental incentives are fundamental to surgical progress, yet financial and professional incentives inherently create conflicts of interest (COI). Understanding how to manage COI held by neurosurgeons, industry, hospitals, and journal editors, without thwarting progress and innovation is critical. To present an overview of COI associated with innovation in neurosurgery, and review ways to manage these in an ethically sound manner. A review of the literature was performed to assess conflicts of interest that affect neurosurgical innovation, and review ways to manage COI of various parties while adhering to ethical standards. COI are inherent to collaboration and innovation, and are therefore an unavoidable component of neurosurgery. The lack of a clear distinction between clinical practice and innovation, ability to use devices off-label, and unstandardized disclosure requirements create inconsistencies in the way that conflicts of interest are handled. Additionally, lack of requirements to compare innovation to the standard of care and inherent bias that affects study design and interpretation can have profound effects on the medical literature. Conflicts of interest can have both direct and downstream effects on neurosurgical practice, and it is possible to manage them while improving the quality of research and innovation. Conflicts of interest are inherent to surgical innovation, and can be handled in an ethically sound manner. Neurosurgeons, device companies, hospitals, and medical journals can take steps to proactively confront bias and ensure patient autonomy and safety. These steps can preserve public trust and ultimately improve evidence-based neurosurgical practice.

For the further training of individuals in neurosurgery: a history of the William P. Van Wagenen Fellowship.

The William P. Van Wagenen Fellowship, celebrating its 50th anniversary, is an annual award given by the AANS and administered by the Neurosurgery Research and Education Foundation (NREF). Named after its benefactor, Dr. William Van Wagenen, the fellowship continues his legacy of mentorship and innovation. As the premier research award for young neurosurgeons, it has provided a foundation for career development for many thought leaders in the field. The award was created in the spirit of Van Wagenen's belief in collaboration with other institutions as a means of refining neurosurgical technique, creating new research initiatives, and improving patient outcomes. Van Wagenen's commitment was informed by his early experiences in neurosurgery with his mentor Dr. Harvey Cushing, who helped to fund Van Wagenen's scientific endeavors in Europe. This journey catalyzed Van Wagenen's lifelong commitment to mentorship, which is exemplified by his instrumental role in the creation of the Harvey Cushing Society, now the AANS. Over the last 50 years, the recipients of this award have used the endowment to lay the groundwork for many scientific and technical innovations in neurosurgery. The fellowship remains an unmatched opportunity to explore new lines of investigation, foster academic and research goals, incorporate new technology and skills into American neurosurgical practice, and motivate young neurosurgeons to transform the field. The legacy of mentorship, scientific inquiry, and clinical excellence personified by Cushing and Van Wagenen is memorialized in the William P. Van Wagenen Fellowship.

Defining Innovation in Neurosurgery: Results from an International Survey.

Innovation is a part of the daily practice of neurosurgery. However, a clear definition of what constitutes innovation is lacking and opinions vary from continent to continent, from hospital to hospital, and from surgeon to surgeon. In this study, we distributed an online survey to neurosurgeons from multiple countries to investigate what neurosurgeons consider innovative, by gathering opinions on several hypothetical cases. The anonymous survey consisted of 52 questions and took approximately 10 minutes to complete. A total of 355 neurosurgeons across all continents excluding Antarctica completed the survey. Neurosurgeons achieved consensus (>75%) in considering specific cases to be innovative, including laser resection of meningioma, focused ultrasonography for tumor, oncolytic virus, deep brain stimulation for addiction, and photodynamic therapy for tumor. Although the new dura substitute case was not considered innovative, there was consensus among neurosurgeons indicating that institutional review board approval was still necessary to maintain ethical standards. Furthermore, although 90% of neurosurgeons considered an oncolytic virus for glioblastoma multiforme to be innovative, only 78% believed that institutional review board approval was necessary before treatment. Our results indicate that innovation is a heterogeneous concept among neurosurgeons that necessitates standardization to ensure appropriate patient safety without stifling progress. We discuss both the ethical drawbacks of not having a clear definition of innovation and the challenges in achieving a unified understanding of innovation in neurosurgery and offer suggestions for uniting the field.

Innovation in Neurosurgery: Intellectual Property Strategy and Academia/Industrial Collaboration.

Neurosurgery has tremendous possibilities for development of innovative medical devices. However, most of the neurosurgical devices used in Japan are imported products. Promotion and development of domestic medical devices is highly encouraged and it is one of the pillars of Prime Minister Shinzo Abe’s growth strategy of Japanese economy. Innovative “Made in Japan” medical devices can be developed by interdisciplinary collaboration between industries and academic institutions. Proper orientation of medical and engineering education, social and administrative awareness of the need of facilitating the medical devices creative process with corresponding regulatory changes, and appropriate medical and technological infrastructure establishment are needed for stimulating medical device innovation.

Technological innovation in neurosurgery: a quantitative study.

Technological innovation within health care may be defined as the introduction of a new technology that initiates a change in clinical practice. Neurosurgery is a particularly technology-intensive surgical discipline, and new technologies have preceded many of the major advances in operative neurosurgical techniques. The aim of the present study was to quantitatively evaluate technological innovation in neurosurgery using patents and peer-reviewed publications as metrics of technology development and clinical translation, respectively. The authors searched a patent database for articles published between 1960 and 2010 using the Boolean search term "neurosurgeon OR neurosurgical OR neurosurgery." The top 50 performing patent codes were then grouped into technology clusters. Patent and publication growth curves were then generated for these technology clusters. A top-performing technology cluster was then selected as an exemplar for a more detailed analysis of individual patents. In all, 11,672 patents and 208,203 publications related to neurosurgery were identified. The top-performing technology clusters during these 50 years were image-guidance devices, clinical neurophysiology devices, neuromodulation devices, operating microscopes, and endoscopes. In relation to image-guidance and neuromodulation devices, the authors found a highly correlated rapid rise in the numbers of patents and publications, which suggests that these are areas of technology expansion. An in-depth analysis of neuromodulation-device patents revealed that the majority of well-performing patents were related to deep brain stimulation. Patent and publication data may be used to quantitatively evaluate technological innovation in neurosurgery.

Scientific and Practical Conference «Innovations in Neurosurgery», October 14-15, 2014, Kiev

Scientific and Practical Conference «Innovations in Neurosurgery», October 14-15, 2014, Kiev

Expanding neurosurgery.

The history of medicine is replete with innovations in neurosurgery that have spurred further developments across the medical spectrum. Surgeons treating pathologies in the head and spine have broken ground with new approaches, techniques, and technologies since ancient times. Neurosurgeons occupy a vital nexus in patient care, interfacing with the clinical symptoms and signs afflicting patients, the pathology at surgery, and imaging studies. No other physicians occupy this role within the nervous system. This power of observation and the ability to intercede place neurosurgeons in a unique position for impacting disease. Yet despite these pioneering achievements, more recently, forces in the workplace may be challenging neurosurgery's opportunities to contribute to the future growth of the neurosciences and medicine. The authors posit that, in the current health care climate, revenue generation by neurosurgical clinical activity is valued by the system more than neurosurgical research and academic output. Without providing the talented stream of new neurosurgeons with the opportunities and, in fact, the directive to achieve beyond simple financial success, the specialty is missing the opportunity to optimize its progress. The authors contend that the key to remaining relevant with the incorporation of new technologies to the treatment of neurosurgical patients will be to be flexible, open-minded, and nimble with the adaptation of new procedures by training and encouraging neurosurgical residents to pursue new or neglected areas of the specialty. Only by doing so can neurosurgery continue to expand.

Improvement and innovation in neurosurgery

Neurosurgery is not an easy job. This is statement is commonsense even among laypeople, as can be noticed by the widespread use of the expression “it’s hardly brain surgery” – in the meaning that an apparently complicated task or procedure is actually not as difficult as it may seem to non-experts (another all around idiom with similar meaning is “it’s hardly rocket science” – note in both cases the use of the adverb “hardly”, not the adjective “hard”). I suspect that most readers of this Journal will agree with the first statement, and the explanation is fairly simple: errors taking place in neurosurgical procedures may have consequences that are far worse in terms of patient morbidity and mortality than what surgeons from other surgical specialties could usually expect. Correspondingly, in order to keep up to their profession’s daily challenge, most neurosurgeons strive throughout life to increase their personal dexterity and technical prowess. However, just a few neurosurgeons go beyond technical self improvement, and actively try to improve and expand the gamut of therapeutic techniques available to their colleagues – although this is ultimately how surgical fields evolve over time. Importantly, improvement and innovation do not need to start from scratch. For example, Leksell, from the Karolinska Institute (Stockholm, Sweden), had to build upon the fields of stereotaxy and radiotherapy to develop stereotactic radiosurgery1. In an more extreme instance, the development of the transphenoidal approach to the sella turcica – first performed with therapeutic purposes by Schloffer in 1907 (Innsbruck, Austria), to treat an hypophisary adenoma2 – had strong inspiration from embalming techniques used by ancient Egyptians over 4000 years ago3. Such improvements in the therapeutic arsenal of neurosurgeons, however diverse from each other they may appear at fist sight, all have a principle in common: what seemed to others as difficulties and barriers was perceived by innovative surgeons as an opportunity to create something new, something better than what was available to them when they first learned their craft. The pretemporal craniotomy, as described in this Number of the Arquivos de Neuro-Psiquiatria, by Chaddad-neto et al.4 presents us with a typical example of those quantum improvements which mark the history of neurosurgery. Treading the path paved by “larger-than-life” neurosurgical personalities such as Yasargil and Drake, the pretemporal approach expands and complements Yasargil’s and Drake’s classic signature techniques5,6, uniting several of their advantages while overcoming most of their technical drawbacks. The deployment of this access, as reported on this article, has been proved useful to treat both neoplastic as well as vascular diseases, and its potential use is limited only by the skill of the surgeon and her/his ability to discover new uses for it. And while it does not seem fair to expect that every neurosurgeon should become an innovator in her/his field, it seems reasonable to expect that any neurosurgeon should try to deliver her/his patients the best among therapeutic possibilities (and within the limits of her/his abilities). In this sense, this article accomplishes the first step of this process of improving the practice of neurosurgery as whole – by delivering to average neurosurgeons an invaluable set of condensed practical information on an innovative and useful technique. For those reasons I could not avoid to hope, while I was reading this paper, that if I ever happen to need the services of a neurosurgeon for a pretemporal craniotomy, I would like that she/he have a good reading of this article before deploying the technique on me. It is, after all, really “hard brain surgery”. Charite Universitaetsmedizin Berlin Institut fuer Vegetative Physiologie.

Surgery of the Mind, Mood, and Conscious State: An Idea in Evolution

Since the beginning of recorded history, humans have sought a physical means of altering disordered behavior and consciousness. This quest has spawned numerous innovations in neurosurgery and the neurosciences, from the earliest prehistoric attempts at trepanation to the electrocortical and anatomic localization of cerebral function that emerged in the 19th century. At the start of the 20th century, the overwhelming social impact of psychiatric illness intersected with the novel but imperfect understanding of frontal lobe function, establishing a decades-long venture into the modern origin of psychosurgery, the prefrontal lobotomy. The subsequent social and ethical ramifications of the widespread overuse of transorbital lobotomies drove psychosurgery to near extinction. However, as the pharmacologic treatment of psychiatric illness was established, numerous concomitant technical and neuroscientific innovations permitted the incremental development of a new paradigm of treating the disordered mind. In this article, we retrospectively examine these early origins of psychosurgery and then look to the recent past, present, and future for emerging trends in surgery of the psyche. Recent decades have seen a revolution in minimalism, noninvasive imaging, and functional manipulation of the human cerebrum that have created new opportunities and treatment modalities for disorders of the human mind and mood. Early contemporary efforts were directed at focal lesioning of abnormal pathways, but deep-brain stimulation now aims to reversibly alter and modulate those neurologic activities responsible for not only psychiatric disorders, but also to modulate and even to augment consciousness, memory, and other elements of cerebral function. As new tools become available, the social and medical impact of psychosurgery promises to revolutionize not only neurosurgery, but also humans' capability for positively impacting life and society.

Device Innovation in Neurosurgery

Innovation in medicine has led to advances directly benefitting patients. Yet recent legislation has created intense scrutiny of the relationship between surgeons and industry. Critics argue that surgeon-held patents and royalties incentivize surgeon loyalty, influencing decision making as to which devices are used intraoperatively. We explored the potential for inventor-related conflicts of interest. We searched patent records from the United States Patent and Trademark Office for every diplomate recognized by the American Board of Neurological Surgeons (4868 neurosurgeons). We also searched physician payment registries of the 5 largest device makers; of these, Medtronic, DePuy, and Zimmer were the only companies with available registries. A total of 147 neurosurgeons (3.0%) hold a total of 582 patents; the number of patents held per neurosurgeon ranges from 1 to 53. The fields in which patents are held include tumor (125), spine (98), vascular (54), trauma (27), stereotaxy/image guidance (88), pain (19), peripheral nerve (2), electrical stimulation (63), and pediatrics (9); surgical instruments (59), drug delivery (17), and other (21) account for the remainder. The total amount of royalties received by neurosurgeons in 2010 is expected to be $13,223,000 (minimum: $7K, maximum: $8.261M). Despite public and legislative perceptions of widespread conflicts of interest, there are relatively few neurosurgeons who hold patents and receive significant royalties.

Surgery of the Mind, Mood, and Conscious State: An Idea in Evolution

Since the beginning of recorded history, humans have sought a physical means of altering disordered behavior and consciousness. This quest has spawned numerous innovations in neurosurgery and the neurosciences, from the earliest prehistoric attempts at trepanation to the electrocortical and anatomic localization of cerebral function that emerged in the 19th century. At the start of the 20th century, the overwhelming social impact of psychiatric illness intersected with the novel but imperfect understanding of frontal lobe function, establishing a decades-long venture into the modern origin of psychosurgery, the prefrontal lobotomy. The subsequent social and ethical ramifications of the widespread overuse of transorbital lobotomies drove psychosurgery to near extinction. However, as the pharmacologic treatment of psychiatric illness was established, numerous concomitant technical and neuroscientific innovations permitted the incremental development of a new paradigm of treating the disordered mind. In this article, we retrospectively examine these early origins of psychosurgery and then look to the recent past, present, and future for emerging trends in surgery of the psyche. Recent decades have seen a revolution in minimalism, noninvasive imaging, and functional manipulation of the human cerebrum that have created new opportunities and treatment modalities for disorders of the human mind and mood. Early contemporary efforts were directed at focal lesioning of abnormal pathways, but deep-brain stimulation now aims to reversibly alter and modulate those neurologic activities responsible for not only psychiatric disorders, but also to modulate and even to augment consciousness, memory, and other elements of cerebral function. As new tools become available, the social and medical impact of psychosurgery promises to revolutionize not only neurosurgery, but also humans' capability for positively impacting life and society.

Editorial: Harvey Cushing

Placing any major surgeon’s achievement in the context of the complex history of his specialty is bound to be difficult and perilous, the more so when the surgeon in question is a prima donna, not inclined toward meticulous or generous acknowledgement of the work of predecessors. The great strength of Dr. Carey’s paper1 is its account of how, in his reports of his battlefield surgery in 1917, Cushing incorporated contributions made by a number of Continental surgeons, notably Barany and Velter, without giving them explicit credit. The Europeans, after all, had been treating brain wounds since the start of their war in 1914. The Americans were late entrants to the conflict and to the surgical problems it posed. Cushing’s apparent reluctance to acknowledge the work of his predecessors can be seen as a case study of the very broad tendency of Americans to believe that nothing particularly important or innovative had happened in the war until they came along and won it. History is now inclined to notice how many lessons the American forces fighting in France had to learn from their allies, and their enemies. Even Cushing came to recognize some of the wisdom, both military and surgical, accumulated by the men who had served far more time in the trenches than the Yankee doughboys and their medics. One of the glories and frustrations of researching history is to find that exercises in contextualizing events can themselves be contextualized. It is somewhat surprising that this paper makes no reference to innovations in neurosurgery before World War I, almost as though no intracranial work had been performed. But of course, many of the techniques used in wartime had been pioneered earlier, some of them in fact by Cushing himself. For many years before the war he had been disdaining any contact between fingers and brain tissue, had been completely shaving patients’ heads, had mastered bone flap techniques, experimented with local anaesthesia, and practiced primary closure, among other techniques. How would the story of wartime neurosurgery read if we traced all the peacetime influences on Cushing’s continental associates? Aside from being malignly influenced by his ego and his arrogance, Cushing was perhaps genuinely conflicted about his relationship to his predecessors. As Carey notes,1 he did, often enough, recognize that his work was unoriginal, especially in any given particular. It was in perfecting the complete experience, the total approach to the surgical problem, from shaving to suturing and everything in between, that Cushing achieved a whole that was greater than the sum of its parts, resulting in what appears to have been a great leap forward in outcomes (assuming that we can trust statistics from that era; Cushing appears to have been unusually rigorous in his use of statistics, but there is considerable room for doubt). To use an inappropriate metaphor, Cushing achieved his good results through an approach characterized by perfectionist overkill. Similarly, his 126-page 1918 paper on his work at Passchendaele was a kind of publishing overkill, the uses of which Cushing well understood. Is it any surprise that this massive and comprehensive article would have been so often cited and so influential as English-speaking surgeons confronted brain wounds in later conflicts? It is not so clear, however, that to have published an extremely influential text on the subject necessarily made Cushing the “originator of brain wound care.” Dr. Carey1 draws this phrase from a 1990 article about craniocerebral injuries in fighting between Israelis and Lebanese. Is he setting up a straw man? To my knowledge no one writing primarily about Cushing’s place in the history of neurosurgery has made a claim for the war work that is nearly so sweeping. In the context of his total contributions to neurological surgery, Cushing’s battlefield experiences in World War I appear to have been derivative and perhaps secondary. It is an important corrective to note how he structured reports of his accomplishments in ways that appeared to slight predecessors and competitors. At the same time, much more could be said about the remarkable dedication with which this senior and aging surgeon (48 years old in 1917) risked his health and his career to serve his country in wartime. He did not shirk and he did not complain, except about the incompetence and laziness of people around him. A case can be made that Cushing’s long hours of work under primitive conditions on one of the bloodiest battlefields in history were his very finest.

Comments on Instrumentation in Neurosurgery

Modern neurosurgery has a brief history of around 100 years. It is called “modern” because its development has been associated with the tremendous progress of modern science and technology. Sharp tools do good work. The introduction of the microscope brought neurosurgery into the era ofmicroneurosurgery, and use of the endoscope has further minimized surgical invasiveness in selected cases. Progress in neurology has made it possible to locate neurologic lesions more accurately. Not only the lesion itself, but also the surrounding vasculature, affected nerves, nucleus and tracts, and functional brain parenchyma are well mapped. The Visual Reality system, which employs three-dimensional image merging techniques, enables the neurosurgeon to make a detailed surgical plan. The neuronavigation system, a great innovation in neurosurgery, has helped neurosurgeons to perform operations with proper orientation. The introduction of intraoperative magnetic resonance imaging (MRI) has eliminated the worry about brain shift during operation. We have used 3.0 T intraoperative MRI for months and find it is of precious value in performing glioma resection to achieve “maximal safe resection.” Furtherprogress shouldbe focused on definitive mapping of brain functional areas, including the motor, sensory, hearing, and visual functional areas and the ways they interact. Resting MRI investigation is valuable in solving positional problems. Brain activity can be evaluated not only by BOLD (blood oxygen level-dependent) techniques but also by physical electric activity and neurotransmitter change, which cannot be well shown with images of high resolution. During vascular surgery, blood flowmonitoring, such as intraoperative digital subtraction angiography, angiography using indocyaninegreendye, andDopplerultrasound, andbrainmonitoring, such as neuroelectrophysiologic monitoring, brain tissue partial pres-