What’s New in Neurosurgery: Advances in Neurovascular and Spine Surgery, Epilepsy Surgery, Surgery for Movement Disorders and Intraoperative Imaging

United States involves the diagnosis and treatment of spine problems. Numerous types of spine instrumentation are available to do spinal fusions. Minimally invasive spine techniques are available, allowing patients having various spine operations to return home the same day. The role, if any, of the artificial disc is being evaluated. There are attempts to close the hole in the annulus of the disc in patients having an operation for disc herniation to assess whether the risk of recurrent disc herniation is decreased. Spacers are being evaluated that are placed between the spinous processes to prevent lordosis in patients with spinal stenosis who have compression of spinal cord and/or nerve roots with extension of the spine. In neurosurgery, in general, and in spine surgery, in particular, the pace of technical advances often has been outpacing demonstrable clinical efficacy. A significant resurgence in the surgical treatment of epilepsy has followed a series of publications over the last 10 years. Wiebe et al. [1] prospectively studied patients with mesial temporal sclerosis, the most common cause of adult intractable epilepsy, and reported their findings in the New England Journal of Medicine . Their publication was the first prospective, randomized study to show definitely that epilepsy surgery was superior to best medical therapy in medically intractable temporal lobe epiCuring problems of the brain without manipulating the brain or without much manipulation of the brain has been the goal of neurosurgeons for decades. Difficult problems such as aneurysms and arteriovenous malformations were dealt with by operating on the cerebral vessels. With the improved technology it now is possible in many patients to block selectively with microcatheters such threatening vascular problems using endovascular coils (or endovascular stents) or injection of substances via the microcatheters to selectively obstruct vessels within the brain. All of this can be done without open operations on the brain. Ischemic stroke was thought to be a condition simply to be diagnosed but not treated. Now, depending upon the time of occurrence, the thrombosed vessel may be treated by antithrombolytic agents and/or microcatheter techniques to remove the thrombus/embolus and insert a microstent to keep the artery patent. Endovascular neurosurgeons have been very active in this area. In some medical centers, these strokes are called ‘brain attacks’ (like myocardial infarction is called ‘heart attack’) to emphasize the need to treat them aggressively and early, if possible. Treatment of spine disorders has undergone a renaissance. Now 75–85% of most neurosurgical practice in the Received: December 1, 2009