Home' Technology Review : July August 2008 Contents ESSAY
Afew months ago, I sifted through a stack ofjunk mail
on my desk---"Neurosurgery Opportunity in North
Dakota," "Advances in Acromegaly," "Katrina, Join
Us in New Orleans!"---and tossed most of it. At the
bottom of the pile was a big, floppy, colorful 2008 calendar
from medical-device maker Medtronic. This I lingered over
for a moment, then saved.
Medtronic's navigation business, which creates technology
that helps surgeons explore the human body, is headquartered
at the foot of the Rocky Mountains. The calendar promised
"stunning imagery from Colorado and stunning innovation
from Medtronic." Take September, which features an "autum-
nal sunset in a thriving aspen forest near Durango, Colorado."
This image is paired with a photograph of a piece of surgical
technology that gets its own loving description: "Medtronic
cranial navigation pointer probes provide an enhanced patient
registration experience for a thriving neuronavigation prac-
tice." I see the connection: thriving forest, thriving practice.
I'll take one of those pointer probes, please.
Where to hang this calendar, though? September might pro-
vide a pleasant piece of art for my o ce, but August, which fea-
tures a blurry and bloody close-up of what I believe is probably
a brain tumor as seen through a surgical microscope, might be
pushing it. ("Doc, that calendar over there: what exactly ... ?")
I figured that my kitchen was out, too.
There was a time when displaying such images made per-
fect sense to me. Years ago, thrilled to have been accepted to a
neurosurgery residency program, I contacted a medical-device
manufacturer to get my hands on a poster featuring detailed
photos of aneurysm clips, which are used to close o a bulging
area in a weakened arterial wall to prevent a hemorrhage in the
brain. I had seen such a poster once before and was amazed
by the clips' variety of configurations and sizes. These small
titanium devices are gems of form and function, perfectly
engineered for their specialized task. Having finished medi-
cal school, I was about to embark on the seven-year training
required to become a neurosurgeon. I wanted that poster.
I am surely not alone in loving the tools of my trade, nor in
finding them physically exquisite. Surgeons are the natural
technophiles of medicine, and neurosurgeons rely at least in
part on especially advanced technologies. But there is a flip
side to the wonder I feel, and it is this: each new technological
advance promises a fresh cause for cursing in the operating
room. Although the details change from decade to decade, and
even from year to year, the source of consternation remains
constant: the fiddle factor. It is, in essence, the same prob-
lem that arises with laptops, cell phones, digital cameras, and
home theater equipment. When the complexity of your home
theater system gets the better of you, though, it just means
that you might not get to enjoy tonight's basketball game in
surround sound. In my job, the fiddle factor can have more
serious consequences. This, after all, is brain surgery.
MEASURE TWICE, CUT ONCE
My profession has come a long way since the dark early days
of exploratory surgery. Before the advent of computed tomog-
raphy (CT) in the 1970s, a surgeon was often guided by clini-
cal judgments about as vague as "It's got to be on the left side."
Things got even better in the 1980s, with advances in magnetic
resonance imaging (MRI). And in the decades since, neuro-
surgeons' ability to target a lesion, such as a tumor---to figure
out where it is in the brain, and then to actually find it at the
time of surgery---has been aided dramatically by advanced
imaging and the technology it has made possible.
The technology that always seems to impress visitors to our
operating rooms is our navigation equipment. ("Navigation"
sounds better than "computerized frameless stereotaxy," so I
will stick with that term.) Simply put, navigation technology
a ords us something like x-ray vision during surgery. With a
specialized wand (or "pointer probe," our Miss September),
Photograph by STEVE MOORS
By KATRINA S. FIRLIK
MANAGING THE FIDDLE FACTOR
IN BRAIN SURGERY
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