Overview Neurosurgery has now evolved from micro-neurosurgery to minimally invasive neurosurgery. Minimally invasive neurosurgery is a minimally invasive operation to protect and restore neurological function, to maximize the patient’s pain, and to minimize medically induced injury. It represents the humanistic culture of human-centeredness and is a manifestation of the new medical model of “bio-psycho-social”. Microscopic neurosurgery is based on modern imaging and a set of surgical equipment and instruments that are compatible with microsurgery, which is a focal point-centered surgery to minimize the damage to brain tissue. Contemporary neurosurgery requires treatment outcomes not only to prevent and reduce post-surgical complications, but also to include anatomical repositioning, as well as to return the patient’s neurological and psychological functions as much as possible. Minimally invasive neurosurgery is a goal to be pursued in all surgical activities, not only limited to a certain treatment method, a certain surgical approach or the application of a certain surgical tool, but the concept of minimally invasive neurosurgery should be applied throughout the entire medical activity, including every step of neurosurgery, such as preoperative, intraoperative and postoperative processes. Carefully explain the condition to the patient and his or her family prior to surgery. The best diagnostic tests should be performed and the preoperative preparation should be completed in the shortest possible time. The patient should be as relaxed as possible and medication should be given if necessary. Preoperatively, plan the surgical treatment plan individually for each patient, taking into account every anatomical and functional detail to make the best surgical plan. Rational anesthesia is chosen for the surgical operation. Intraoperative neurological function monitoring is performed. The core goals of minimally invasive neurosurgery are accurate pathway positioning, shortening the surgical pathway to provide adequate operating space; and reducing interference and damage to the central nervous system and vascular structures during surgery. The impact of post-healing scar on the patient’s face is considered when closing the cranial suture. Postoperative management includes avoiding postoperative patient pain and minimizing the observation time in the ICU. Retain access saline heparinization and try to take oral medications to discharge the patient early. Before discharge, explain to the patient and his family the mode of review, interval and further treatment plan after discharge. Patients can be contacted by phone after discharge. With the development of imaging including cranial CT, MRI, DSA, PET and other diagnostic tools updated, detailed anatomical information is provided for neurological lesions and surrounding normal tissue structures, allowing neurosurgeons to make localized diagnosis of lesions and pathological diagnosis of most lesions making preoperative treatment planning for each patient more complete. This has raised the bar for neurosurgery. The continuous emergence of surgical microscopes, neuronavigation, neuroendoscopy, various delicate surgical instruments, and the skilled use of microsurgical techniques have raised microscopic neurosurgery to a new level. The continuous progress of the times, the higher requirements of patients, and the support of newer scientific and technological achievements have driven the rapid development of medicine, and as a branch of minimally invasive surgery, minimally invasive neurosurgery has emerged. It includes all kinds of emerging minimally invasive neurosurgery, interventional therapy and stereotactic radiotherapy. The content of minimally invasive neurosurgery Minimally invasive neurosurgery includes six aspects ① image guided surgery ② micro-bone window access; ③ neuroendoscopic assisted surgery ④ intravascular embolization ⑤ stereotactic radiosurgery ⑥ molecular neurosurgery I. Image-guided neurosurgery, also known as neuro-navigation or frameless stereotactic surgery, is an important part of current minimally invasive neurosurgery. As navigation surgery combines modern neuroimaging diagnostic techniques, stereotactic surgery and microneurosurgery techniques, through high performance computers, it can accurately, dynamically and in real time display the 3D spatial location of the anatomical structures and lesions of the nervous system and their adjacent relationships. Advantages of neuronavigation It has the following advantages over framed navigation surgery: ① preoperative surgical plan design; ② intraoperative real-time 3D spatial localization; ③ display of structures around the operative field; ④ pointing out the 3D spatial relationship between the current surgical position and the target site; ⑤ intraoperative adjustment of the surgical approach in a timely manner; ⑥ display of structures that may be encountered in the approach; ⑦ display of important structures; ⑧ display of the extent of lesion resection. It is applied to various intracranial occupying lesions (such as tumors, cysts and abscesses, etc.), vascular malformations, epilepsy, skull base tumors, congenital or acquired malformations, sinus, spinal and spinal cord lesions, etc. Once the patient data is registered, the system can track first the surgical probe and thus track the procedure with millimeter accuracy. Smaller incisions, more precise removal of diseased tissue and reduced damage to surrounding normal tissue reduce post-surgical complications and improve prognosis. Open MRI navigation technology has improved the safety, efficacy and performance-to-price ratio of surgery and has advanced neurosurgery. Intraoperative MRI provides useful imaging information for navigation, determination of intracranial tumor boundaries, complete and safe tumor removal, and reduction of surgical complications. The application of intraoperative MRI navigation system provides a broad prospect for the development of neurosurgery. In particular, the emergence of surgical units that integrate neuroimaging, anesthesia and surgical equipment allows surgery to be completely placed in the midst of imaging, and surgeons can readily subject patients in surgery to MRI to determine the status of the operation in progress, guide the surgery and improve the surgical outcome. This method of applying open MRI in surgery has changed the traditional concept of surgery, and it is believed that this kind of surgical unit with high-end technology will be promoted and applied in the clinic in the near future. Second, the microbone window access surgery Microbone window access surgery is one of the symbols of minimally invasive neurosurgery, the advantages of which are small medical source of injury, light post-operative reaction, and good surgical results. With the development of micro-neurosurgery technology and the advancement of neuroimaging technology, the detection rate of some small and deep intracranial tumors has been improved, and the anatomical localization of lesions is more accurate. The use of micro-neurosurgery techniques, yes the use of small scalp incisions, micro-bone window access, as well as less exposure and less involvement of normal tissues around the lesions, surgical treatment of these lesions became possible, thus changing the traditional craniotomy approach. In particular, the introduction of intraoperative navigation technology has provided a reliable technical guarantee for the emergence and promotion of the microbony window approach technique. Advantages of microbone window approach Narrow scalp incision and bone window, reduce exposure and disturbance of normal brain tissue range; less surgical injury, reduce complications associated with traditional craniotomy, such as postoperative epilepsy, postoperative hematoma, etc., improve surgical safety; shorten the time of opening and closing the cranium, reduce surgical bleeding; keep the patient’s external appearance good; patients recover quickly after surgery. It is especially suitable for deep brain lesions, such as: skull base tumor, saddle area tumor, pontocerebellar horn tumor, intracranial aneurysm, etc. However, this approach is not suitable for huge skull base tumors, arteriovenous malformations and hemorrhagic aneurysms. The microbone window approach is based on microsurgical techniques and should be equipped with perfect surgical microscopic equipment and instruments, such as controllable surgical bed, high-speed cranial drill, head frame and surgical microscope. Special microdissectors and intracranial automatic retractors are available. With the introduction of navigation technology, the micro-bone window access makes neurosurgery reach a new level of minimally invasive, and will have a wider application prospect with the support of neuronavigation technology and neuroendoscopy. Neuroendoscopy-assisted surgery Neuroendoscopy-assisted surgery: using neuroendoscopy, also known as ventriculoscopy, to assist neurosurgery can reduce the scope of craniotomy, magnify the anatomical structures in the surgical field image to enhance the local illumination and improve the surgical effect, which is an important technique of minimally invasive neurosurgery. Neuroendoscopy-assisted microsurgery for intracranial aneurysms, arachnoid cysts, microscopic intracerebroventricular lesions, and removal of pituitary tumors through a single nostril has yielded good results. Advantages of neuroendoscopy: 1. The endoscopic view tube itself can have a lateral view, which can eliminate intraoperative dead space 2. With the help of stereotactic or neuronavigation technology, it can precisely locate and deal with areas that are difficult to reach by conventional surgery, and is especially suitable for surgery of lesions in deep brain or midline areas. 3. Neuroendoscopy is more suitable for micro-bone window access and less invasive surgery. Limitations of neuroendoscopy: 1. The neuroendoscope itself is limited by the diameter of the tube, the field of view is small, the operating space is small, it is difficult to observe the whole picture of the surgical field, if the anatomy of the surrounding tissues is not clear, the ability to cope with surgical accidents is poor, and it is very easy to lead to operational errors. Neuroendoscopic surgical operation requires a certain amount of space, so the image display in the brain parenchyma is not clear and cannot be applied. 2, The biopsy histological specimens obtained by neuroendoscopy are too small and lack conclusive pathological diagnosis, this problem should be fully estimated and should be explained to the patient before surgery. 3, neuroendoscopic surgery, need to be matched with more slender, specific shape, suitable for deep operation instruments, the degree of matching and reasonable degree of instruments can sometimes have a great impact on the length of surgery, and even on the surgical results. Neuroendoscopy is only a tool for perioperative surgery, and it cannot be used in surgery simply to pursue the application of neuroendoscopy and arbitrarily expand the indications for surgery, which can cause serious medically induced injuries. Interventional neuroradiology Interventional neuroradiology: It is a method to deliver drugs or other special materials into the lesion area of central nervous system with the help of guiding instruments (catheter, guidewire, etc.) under X-ray monitoring to achieve the treatment purpose of embolization, dissolution, expansion, shaping or anti-tumor. The main targets of treatment are intracranial aneurysms, arteriovenous malformations of the brain and spinal cord, arteriovenous fistulas, dural arteriovenous fistulas, arterial and venous sinus stenosis, acute cerebral infarction, and head and neck tumors. The treatment techniques are divided into endovascular embolization, intravascular drug perfusion and angioplasty. The access or treatment targets for the above treatment procedures are the relevant arteries and draining veins, hence the names endovascular neurosurgery and endovascular neurosurgery. The greatest advantage of interventional neuroradiotherapy is that it avoids the tissue trauma associated with open surgery and is an important part of minimally invasive neurosurgery. At present, the scope of interventional neuroradiotherapy is being broadened, the scale is expanding, the effect is improving day by day, occupying an increasingly important position in the field of neurosurgery, especially for the treatment of cerebrovascular disease has made many breakthroughs, showing a broad prospect and field with strong vitality. Five, stereotactic radiosurgery stereotactic gamma knife: the indications for gamma knife treatment should be based on the nature of the lesion, size, location, and the relationship with the adjacent important structures, as well as the patient’s age, general condition and other factors to determine a comprehensive. In general, small and medium diameter intracranial lesions, such as AVM, benign intracranial tumors, metastatic tumors, some malignant tumors, intracranial base and orbit, nasopharyngeal tumors, some functional neurosurgical diseases, etc., if the boundary of the lesion is clear, gamma knife treatment can be chosen. Gamma knife treatment is not a good choice especially for lesions located in deep and important functional areas, difficult to be removed by conventional surgery or more traumatic and with higher complications, as well as for patients of advanced age, poor general condition, or with systemic diseases that cannot tolerate surgical procedures. For postoperative residual or early recurrent intracranial AVMs and tumors, Gamma Knife is also a complement to other treatments. There is generally a significant change within the recent clinical presentation after Gamma Knife treatment, and the emergence of efficacy is a delayed and gradual process. The method of evaluating the efficacy is mainly based on whether the tumor continues to grow (enlargement) by imaging, whether the AVM shrinks until it disappears and the improvement of clinical symptoms. At the same time, because most of the complications caused by gamma knife treatment also occur 1~18 months after treatment, therefore, the clinical and imaging follow-up is more important. Molecular neurosurgery Molecular neurosurgery: the use of molecular biochemical techniques to treat neurosurgical diseases is still in the research stage. It involves cranial tumors, cerebrovascular diseases, neurological injuries, neurofunctional diseases and neurodegenerative diseases. 1. gene therapy for brain malignancies 2. neural stem cells for experimental treatment studies of brain and spinal cord injuries 3. gene chips and proteomic technologies 4. cell transplantation for recovery of brain function after stroke in animal experiments and clinical trials. Although intracerebral transplantation can not solve all the difficult neurological problems, repair and rebuild neurological function. And there are still many unresolved problems. But intracerebral transplantation is certainly one of the hot spots of neuroscience research and the most promising way to treat degenerative diseases of the central nervous system.