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- A Brief History Of Brain Tumour Surgery Around The World
A Brief History Of Brain Tumour Surgery Around The World
Brain tumours are among the most challenging medical conditions a patient can have. Until relatively recently, there was no effective means of treating them. Part of the problem was that even a clear diagnosis was impossible, except in post-mortem cases, until technology like CT scans was developed.
This, of course, is part of a wider story of the development of medicine down the years, both in terms of diagnostic methods and surgery. The effectiveness of the latter has been tied in with developments in anaesthetics and the sterilisation of surgical instruments.
Anyone who has undergone any form of surgery will be glad for the developments that have made such treatments possible. To carry out brain tumour surgery, however, represents a further step, as it means seeking to excise tumours in a process that risks wider damage to the most vital organ in the body and may require opening up the skull.
This makes surgery on brain tumours a specialised skill, but it has been developed extensively down the years as scientific and medical understanding of the brain, technology and techniques have developed.
A glioma, a kind of tumour that starts in the glial cells of the brain or spinal cord, is a prime example of the type of tumour that may be treated with surgery, although other treatments such as radiotherapy or chemotherapy may be used alone or in combination. It can be benign or malignant, but in either case it cannot be ignored.
The operation in question was carried out by Scottish surgeon William Macewen in 1879. This went largely unrecognised at the time and the title of pioneer of this landmark operation has sometimes been attributed to Sir Rickman John Godlee for a procedure carried out in 1884.
By definition, such pioneers had no prior experience and none of the scanning equipment available today. Moreover, while today there are several forms of surgery available, in the early years the only available method was craniotomy, where part of the skull had to be removed to enable the surgeon to access the tumour.
While instances of the use of endoscopes in brain surgery date back to 1910, it is only from the 1980s onwards with the emergence of fibre optics that its use in minimally invasive brain surgery has become commonplace.
Similarly, MRI-guided laser ablation is also guided by fibre optics, with a very small hole made in the scull and the fibres passing through, delivering heat via a laser to burn away the tumour.
In addition to the above, a biopsy, which takes a small sample of tissue to establish what kind of tumour it is, will also be invasive, although on a small scale, especially with modern technology.
A gamma knife works by directing intense beams of radiation at the tumour, which can help shrink it, the precision of the device also minimising the exposure of the surrounding brain tissue.
Strictly speaking, gamma knife treatment is a form of stereotactic radiotherapy, rather than surgery. However, this and other forms of radiotherapy have nonetheless impacted on surgery, as the shrinkage they can produce can make the task of surgically removing part or all of a tumour easier.
This means it is increasingly possible to combine brain tumour surgery with radiotherapy, as well as other treatments such as chemotherapy. As a result, oncologists have a much wider array of options for treatment for patients.
Factors such as the size and location of the tumour, how far it has progressed and the response to other treatments will all shape decisions over surgery. What is clear, however, is that the advancement of this form of surgery over the years means the prognosis for patients is far more positive than it was in the days of the Victorian pioneers.
Learn more about our advanced radiotherapy and neurosurgical treatments for brain tumours on the Queen Square website.
This, of course, is part of a wider story of the development of medicine down the years, both in terms of diagnostic methods and surgery. The effectiveness of the latter has been tied in with developments in anaesthetics and the sterilisation of surgical instruments.
Anyone who has undergone any form of surgery will be glad for the developments that have made such treatments possible. To carry out brain tumour surgery, however, represents a further step, as it means seeking to excise tumours in a process that risks wider damage to the most vital organ in the body and may require opening up the skull.
This makes surgery on brain tumours a specialised skill, but it has been developed extensively down the years as scientific and medical understanding of the brain, technology and techniques have developed.
A glioma, a kind of tumour that starts in the glial cells of the brain or spinal cord, is a prime example of the type of tumour that may be treated with surgery, although other treatments such as radiotherapy or chemotherapy may be used alone or in combination. It can be benign or malignant, but in either case it cannot be ignored.
The First Brain Tumour Surgeons
Given the need for surgery to develop as a medical discipline before anything so precarious as brain surgery might be attempted, it may come as little surprise that the first successful recorded case of a brain tumour being removed surgically did not occur until the late 19th century.The operation in question was carried out by Scottish surgeon William Macewen in 1879. This went largely unrecognised at the time and the title of pioneer of this landmark operation has sometimes been attributed to Sir Rickman John Godlee for a procedure carried out in 1884.
By definition, such pioneers had no prior experience and none of the scanning equipment available today. Moreover, while today there are several forms of surgery available, in the early years the only available method was craniotomy, where part of the skull had to be removed to enable the surgeon to access the tumour.
Fibre Optics And Minimal Invasion
Subsequent developments produced less aggressive means of accessing tumours. For example, endonasal endoscopy allows the surgeon to access the front of the brain via an endoscope inserted via the patient’s nostril. A Neuroendoscopy allows a tube to be inserted through a small hole in the skull.While instances of the use of endoscopes in brain surgery date back to 1910, it is only from the 1980s onwards with the emergence of fibre optics that its use in minimally invasive brain surgery has become commonplace.
Similarly, MRI-guided laser ablation is also guided by fibre optics, with a very small hole made in the scull and the fibres passing through, delivering heat via a laser to burn away the tumour.
In addition to the above, a biopsy, which takes a small sample of tissue to establish what kind of tumour it is, will also be invasive, although on a small scale, especially with modern technology.
The Impact Of Gamma Knife
The most technologically advanced form of surgery is non-invasive: the Gamma Knife. This was originally devised in 1967 by Swedish scientist Lars Leksell for treating other neurological conditions, but its potential for tackling brain tumours was so obvious that it was to be deployed this way from 1975, when Prof Leksell and colleagues built a second device.A gamma knife works by directing intense beams of radiation at the tumour, which can help shrink it, the precision of the device also minimising the exposure of the surrounding brain tissue.
Strictly speaking, gamma knife treatment is a form of stereotactic radiotherapy, rather than surgery. However, this and other forms of radiotherapy have nonetheless impacted on surgery, as the shrinkage they can produce can make the task of surgically removing part or all of a tumour easier.
This means it is increasingly possible to combine brain tumour surgery with radiotherapy, as well as other treatments such as chemotherapy. As a result, oncologists have a much wider array of options for treatment for patients.
Factors such as the size and location of the tumour, how far it has progressed and the response to other treatments will all shape decisions over surgery. What is clear, however, is that the advancement of this form of surgery over the years means the prognosis for patients is far more positive than it was in the days of the Victorian pioneers.
Learn more about our advanced radiotherapy and neurosurgical treatments for brain tumours on the Queen Square website.
