Computer-assisted neurosurgery.

Computer-assisted neurosurgery has become so successful that it is rapidly becoming indistinguishable from, quite simply, neurosurgery. This trend promises to accelerate over the next several decades, bringing considerable benefit to the patients we care for. From a pragmatic point of view, can we identify specific instances in which clinical practice has been altered by computer assistance? During craniotomies for the resection of brain tumors, this technology has led to a greater standardization within and among practitioners for the expected degree of resection and the risk of morbidity and mortality. Minimally invasive approaches are transforming the practice of cranial base surgery. This technological trend has made craniotomy for biopsy virtually obsolete in the face of frameless stereotactic techniques. Functional neurosurgery has benefited from these technologies, as deep brain stimulation surgery has become the standard of care for most cases of movement disorder surgery. Extratemporal epilepsy due to cortical dysplasia has proven especially amenable to image-guided surgical techniques that integrate electrophysiological monitoring to refine the target of resection. New surgical procedures made possible by computer assistance include minimally invasive spine surgery, endovascular procedures, resections of low-grade nonenhancing gliomas, and stereotactic radiosurgery. A program for future research and development in this field would include: Electronic patient medical records. Automatic dynamic and elastic registration Novel surgical instrumentation guided by augmented reality Real-time feedback using anatomic and functional information Active robotic servo control systems to amplify neurosurgical capabilities Outcomes analysis-driven refinement of neurosurgical interventions. It is apparent that using computer assistance in neurosurgery has begun a process that will irrevocably transform all of neurosurgical practice itself. It must be neurosurgeons themselves who provide the leadership to transcend the potentially distracting aspects of this technological revolution. What shall not change is the commitment that we, as neurosurgeons, have to the welfare of our patients.