CAN/CAM: Computer Aided Neurosurgery / Computer Aided Microsurgery | Dr. Prem Pillay, Singapore

Making Neurosurgery more effective and safe

Neurosurgery refers to surgery of the brain, spine and nerves.

Micro-Neurosurgery is the use of an operating Microscope to allow smaller openings to be made to reach brain, spine and nerve problems and to aid delicate surgery on these parts to cure a disease. The latest generation of microscopes is now digital rather than analogue

A craniotomy is done to treat various problems in the brain such as brain tumours, anerysms, blood clots, abscesses and head injuries.

The goal of neurosurgery is to effectively treat the brain or spine disease completely with minimal side-effects.

Currently, brain and spine surgery is made more effective and safer with the use of computer digital (CAN/CAM) technology. This provides sophisticated navigational information to the neurosurgeon through a special microscope to guide precision and delicacy in brain and spine surgery.

The Procedure

  • Special stickers (Fiducial markers) will be stuck on to your head or spine in the areas of your problem/lesion.
  • You will then go for a special MRI or CT scan that will be used for the surgical planning (your earlier MRI was for diagnostic purposes). During the scan various cuts of your head/spine are imaged in different views (top/bottom, front/back, side/side).
  • After the scan you will rest in your room till the time of your surgery. Please note that the stickers on your head should not be removed. It can only be removed by your Neurosurgeon in the Operating Room (OR). The images from the CT or MRI scans are saved onto a digital audio tape or optical disc which is transferred to the Computer Station in the OR.
  • Once the images are loaded onto the computer workstation, your whole head or spine is reconstructed in 3-dimensions (3-D). The lesion in your brain (tumor, abscess, blood clot etc) and critical areas of the brain/spine eg. blood vessels, the optic nerve can be similarly reconstructed in 3-dimensions. Your Neurosurgeon can determine the safest access to your lesion with minimal damage to critical brain/spine areas. This allows him to make a smaller opening (craniotomy) in your brain or smaller spinal access. You will be brought to the OR and met by your surgical team (your Neurosurgeon, his neuroanaesthetist and the neuronurse).
  • Once you have been put to sleep, a special probe is used to touch the various parts of your head/spine to register your position in space with that of the 3-D computer image. By this means, your Neurosurgeon will know at any point of time where he is in your brain/spine during the surgery.
  • The most advanced digital microscope is integrated to a computer workstation (Zeiss NC-4 with the StealthStation).
  • Robotic brain micro-surgery is also available (Surgiscope).

Using state of the art CAN/CAM technology, your brain/spine surgery is now:

  • more accurate
  • less invasive
  • safer with minimal damage to critical normal brain or spinal nerves.

After surgery you may be in the ICU, and then can be discharged usually within 24-72 hours.

With any type of surgery the most common risks are internal bleeding, infection and anaesthetic risks.

Computer-guided Microneurosurgery helps the Neurosurgeon minimize these risks for you.

Contributed by:
Dr Prem Pillay
Consultant Neurosurgeon
Mt Elizabeth and Gleneagles Hospitals
Visiting Consultant, Singapore Gamma Knife Centre