When it comes to neurosurgery, many parents ask: Can this surgery be minimally invasive? Is it open? How big is the surgical wound? In fact, minimally invasive, craniotomy, and size of incision are three different concepts, and there is no absolute equivalence, nor can they be evaluated or referred to each other. It is hoped that through this article, parents will be able to correctly treat the concept of “minimally invasive”, not to be superstitious in the unreasonable minimally invasive, but also not to miss the opportunity to bring less harm to the child. “Minimally invasive” is a surgical concept First of all, I would like to explain the concept of minimally invasive. First, I would like to explain the concept of minimally invasive. Minimally invasive means “tiny”, or more appropriately, “to make it tiny”, which is the goal pursued by neurosurgeons; while “invasive” refers to traumas not only obvious wounds on the surface of the skin, or wounds in the hands of the surgeon. The term “trauma” refers not only to the obvious wounds on the surface of the skin or the bones that can be reached by hand, but also to the trauma caused to the internal tissues. Minimally invasive is a concept, not an absolute treatment, and not the size of the surgical incision. The concept of minimally invasive is to minimize overall and long-term harm to the patient, and any treatment strategy that improves the safety and long-term prognosis of the patient’s surgery can be said to be consistent with the concept of “minimally invasive”. For all surgical procedures, especially neurosurgical procedures, surgeons are striving to minimize trauma to the patient. Skin incisions and “craniotomies” ≠ surgical trauma In the field of neurosurgery, we protect from the inside out. That is to say, in order to protect the important brainstem, brain nerves and blood vessels, we would rather sacrifice part of the brain tissue that has no obvious function if necessary. Second, in order to protect brain tissue, we would rather sacrifice the skull, especially the bones at the base of the skull, if necessary. Again, in order to protect the skull, we would rather sacrifice muscle and scalp incisions when necessary, because the most important part, the part that affects the child the most, is in the deep side, in the inside, and never in the surface incisions and bones. We evaluate the damage of a neurosurgical procedure on a child, again from the inside to the outside, and only when the important tissues inside are protected can we step by step evaluate the size of the external scalp and skull damage. The pursuit of small incisions and small bone windows may result in insufficient exposure of deeply operated brain tissues, cerebral vessels, and cerebral nerves, leading to more serious damage. Therefore, the pursuit of the protection of brain tissue, nerves, blood vessels and other important tissues, so that the child is safe during and after surgery, as soon as possible to recover, and minimize surgery-related complications, which is truly minimally invasive. The incision should also not be ignored Is it true that the larger the incision, the more fully it is opened, the better the protection of the important brain tissue inside? Not really! Although the scalp incision and skull are relatively less important than the brain nerves and blood vessels, they are not unimportant. Properly designing the incision location and controlling the size of the incision can partially reduce intraoperative bleeding and superficial tissue damage (such as nerves controlling skin sensation), as well as ensure aesthetics. Therefore, under the premise of being able to achieve the same surgical results and long-term prognosis, neurosurgeons, especially our pediatric neurosurgeons, will also try to reduce the size of the incision to ensure that the incision is aesthetically pleasing, after all, it is also a lifelong child’s event. -For example, for a ventriculoperitoneal shunt surgery, my incision in the head is only 3cm long, and the incision in the abdomen is only 2cm long, so this kind of incision allows me to complete the surgery with ease – in this case, I will never give the child an extra incision of even 1cm incision. –For example, in a subcerebellar tonsil hernia, my usual incision is 3-4 cm, which in most cases allows me to adequately decompress the occipital and posterior atlantoaxial arches, resect the atlanto-occipital fascia, expand the dura mater, and partially resect the herniated subcerebellar tonsils and explore the exit of the quadricle ventricle. –For example, in medulloblastoma surgery, I usually make an incision of only 5 cm, so that the total resection of the tumor and the opening of the cerebrospinal fluid circulation can be accomplished. These are the decisions of different doctors based on their personal experience, philosophy and habits. Therefore, please put aside your misunderstanding of the term “minimally invasive” and listen to your doctor’s advice and consider your child’s treatment plan from a more comprehensive and long-term perspective. Most neurosurgeons will consider all aspects of the surgery and choose the procedure that is best for your child.