The field of neurosurgery is one that is continually advancing thanks to innovative technology and research. NorthShore's team at the Neurological Institiute, including Dr. Ricky Wong, have developed techniques to treat conditions such as brain tumors with much major benefits to patients. Dr. Wong discusses the latest below:

What are some of the more common conditions that require neurosurgery?
Neurosurgery deals with all aspects of the brain, spine and nerves. When it comes to the brain, the most common conditions involve brain tumors or vascular disorders, such as aneurysms and arteriovenous malformations.

This area of surgery has shown a lot of development over the past several years – how has treatment through neurosurgery changed?
Neurosurgery has changed dramatically. This has been driven by a research into the science behind neurosurgical diseases, an improved understanding of the complex anatomy, and advancements in technology. When treating complex brain disease, tumors in particular, we have historically used large incisions and exposures. With our improved understanding and advanced technology (in mapping, accessing, visualizing and removing tumors), we are now able to treat extraordinarily complex tumors with very small, and occasionally no, incisions.

What are some of the innovative procedures that are being adopted at NorthShore?
Some of the innovative minimally invasive techniques we employ at Northshore include endoscopic endonasal surgery and keyhole surgery.

How have physicians and patients benefited from advancements in endoscopic technology?
Endoscopes have revolutionized the way we perform neurosurgery. It allows us to see everything better, clearer and even around corners. This allows us to perform surgery through progressively smaller openings and manipulate the normal brain, nerves and blood vessels less. We now have special endoscopes that can even light up tumors (distinguishing it from normal brain) and endoscopes that create a true three dimensional picture of the surgery.

Can you tell us about the “keyhole” tumor removal procedure you’ve performed? (What it is used for, how it works)
A “keyhole” procedure is using a very small opening – typically the size of a quarter or less – to access deep areas of the brain. It can be used to treat a wide variety of diseases, including brain tumors and aneurysms. The process starts with figuring out where to place the “keyhole.” Generally, I make a small one-inch incision hidden within the hair or eyebrow. The placement of the incision is carefully planned with brain mapping technology. Once the incision is made, a quarter sized opening in the bone is made and a combination of microscopes and endoscopes are used to provide complete visualization. Once the tumor is removed, the hole in the bone is replaced and the skin is closed.

How do you determine whether this procedure would be appropriate for a patient?
This is often to most difficult part as careful selection is extremely important to success. I utilize advanced three dimensional mapping of the brain and tumor, along with occasional work in the simulation lab for extremely difficult cases to ensure it is the right and safe approach. Experience is critical and I do a very high volume of keyhole cases.

What does this procedure mean for patients in terms of recovery?
Patients often have a dramatically faster recovery time, shorter length of stay in the hospital, and improved outcomes and cosmetic appearance. For perspective, a procedure that used to mean 4 or 5 days in the hospital only a few years ago, now involves typically a 1 or 2 day hospital stay.