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Dr. Prem Pillay, Singapore Senior Consultant Neurosurgeon with super specialty training in Neurosurgical Oncology (Fellow at MD Anderson Cancer Center and Hospital, U of Texas, USA) Introduction Brain and spine tumours refers to tumours that grow in or around the brain and the spinal cord and can cause severe disability and even death if undetected and untreated by damaging the central nervous system. According to Dr Prem Pillay, a Senior Neurosurgeon and Neurosurgical Oncologist in Singapore, the number of people affected by these tumors is increasing because of better detection and also our aging population. These tumors can also affect children. There are two categories of brain and spine tumors. There are those that are benign and often slow growing such as Meningiomas, pituitary tumors ,Scchwannomas and acoustic neuromas. These are often seen in adults and can sometimes reach a large size by the time symptoms appear and are recognized. Dr Prem Pillay advocates early detection in order to increase the chance of a smaller tumor size at diagnosis. This could make treatment more effective and safer . The second category of tumors are those that are more malignant. They either start in the brain or spinal cord or come from elsewhere to that location. Someone who has breast or lung cancer can have spread of this cancer to the brain or spinal location. Malignant tumours that start in the brain or spinal cord are often Gliomas including astrocytomas. Diagnosis Brain tumors can cause headaches, seizures, weakness of a limb or limbs, loss of sensation, and loss of one the senses (smell, taste, vision, hearing, balance). However, Dr. Prem Pillay cautions that headaches are common and are more often from tension and migraines than a brain tumor. However, the presence of the other problems mentioned should lead one to a doctor for a neurological and spinal examination. Spine tumors can present with back pain, neck pain and loss of strength or feeling in the arms or legs or sometimes both. However, again Dr. Pillay observes that neck and back pain is often from slipped discs or spine degeneration rather than a spine tumor. Evaluation of the problem by a qualified specialist can help in arriving at a diagnosis and the proper use of tests including MRI and CT (computed tomography). In order to confirm the diagnosis, useful tests include MRI of the brain and the spine. The MRI does not use radiation but a magnetic field to arrive at images that can clearly show the nervous system of the brain and the spine and any tumors. The size and location of tumors can be precisely determined. PET-MRI (Positron Emission Tomography) of the Brain and whole Body when indicated is another test to determine a cancer.  A Biopsy is often needed to know the tumor type. This can either be done during the operation for tumor removal or using a needle. The needle type biopsies are now often computer and image guided meaning that MRI or CT technology is used for navigation and precision. New types of biopsy include Liquid biopsy of the blood or the CSF (Cerebrospinal Fluid). Molecular profiling of tumor fragments including circulating DNA and cell fragments can be done using NGS (Next Generation Sequencing). Modern Treatments In the past the treatment modalities for brain and spinal tumors in adults and children was often limited to the use of surgery alone often with attempts at radical removal with large openings. Modern surgery includes the use of advanced neuro microscopes with fluoroscopic imaging capabilities, Computer Guidance linked to MRI and CT scans, and finer tools for tumor removal. Parts of the tumor that are difficult or risky to remove can be treated later by other modalities such as Stereotactic Radiosurgery (SRS). According to Dr Prem Pillay, Stereotatic Radiosurgery has become a major and useful tool in the treatment of both brain and spine tumors. Stereotactic Radiosurgery uses precision and guided energy beams that penetrate painlessly and invisibly to the tumor site without needing an open operation. In the past there was the Gamma knife but now there are a wider range of radiosugery platforms including Tomotherapy, LINAC (linear accelerator/Photon) systems with micro-multileaf collimators for high precision, Robotics and the ability to treat the brain and the spine. There is also Proton Therapy for treating tumors of the Brain and Spine. There are tumors that can be treated with Stereotatic radiosurgery alone without open surgery as the first step. Malignant tumors may need several modalities of treatment including surgery, radiation and chemotherapy and/or Immunotherapy. Conclusions Although brain and spine tumors can be dangerous and devastating in adults and children ,Dr Prem Pillay believes that earlier diagnosis and the use of technologically advanced tools including microsurgery, robotics and radiosurgery is playing a role in saving many lives throughout the world including Singapore. With many years of experience in treating Brain and Spine Tumors and access to the latest technological advancements, Dr Prem Pillay offers patients the highest standard of care. From accurate diagnosis to tailored treatment plans, our approach ensures the best possible outcomes for individuals affected by this challenging condition. If you or a loved one has been diagnosed with a Brain and Spine Tumor / Cancer problem, we welome you to seek a consultation with our specialized team. Together, we can develop a comprehensive evidence based and personalized treatment strategy that addresses your unique needs and provides the best chance for a positive outcome. *FELLOW IN NEUROSURGICAL ONCOLOGY, MD ANDERSON CANCER CENTER AND HOSPITAL, USA.

Dr. Prem Pillay, Singapore Senior Consultant Neurosurgeon with super specialty training in Neurosurgical Oncology (Fellow at MD Anderson Cancer Center and Hospital, U of Texas, USA) What is an Acoustic Neuroma? An acoustic neuroma is an intra-cranial (within the head but outside the brain) tumor that arises from the superior vestibular nerve (a nerve for balance). The more accurate term is therefore vestibular schwannoma. Histopathology They are firm and encapsulated and classified as benign. Antoni A and Antoni B biphasic patterns are found. They can be cystic, hemorrhagic or entirely solid tumors. Malignancy is rare. Location I t starts in the internal acoustic meatus but can grow medially towards the brainstem and occupy space in the cerebellopontine angle. Related tumors Trigeminal schwannoma, facial nerve schwannoma, hypoglossal schwannoma and glossopharyngeal nerve schwannoma,  can occur in the same location (Cerebellar Pontine Angle or CP angle). Symptoms / Presentation This includes tinnitus (ringing in the ears), hearing loss, imbalance, numbness of the face, weakness of the face, difficulty in chewing and swallowing (caused by compressing nerves, brainstem and cerebellum in the CP angle as the tumor grows).  Large tumors may cause hydrocephalus by obstructing CSF circulation and this may cause symptoms related to this condition. Large tumors may cause coma, paralysis and death. Diagnosis: It can be overlooked in the early stages and the diagnosis missed as tinnitus and mild hearing loss are often not investigated with MRI scanning.  The best single test is MRI of the brain and IAM (internal acoustic meatus) with contrast (gadolinium). Hearing and balance tests can document the effects of the tumor. Treatment: There are in general, three options: Monitoring of small tumors (< 1cm in size) if hearing is still intact is an option in older patients and in younger patients with bilateral tumors associated with NF (Neurofibromatosis, NF-2). This includes clinical and hearing tests supplemented with regular MRI scans. If the tumor increases in size and significant hearing loss occurs treatment is recommended. Surgery and tumor excision was once the only  treatment option for most of the 20th century. Microsurgery, improved anesthesiology, Image-guidance , better microsurgical tools and nerve monitoring have improved the results of surgery. Microsurgery may still be the best treatment option for large tumors (>3.5cm) in selected patients who have symptoms from the mass effect of the tumor. Radiosurgery is now an accepted treatment modality for acoustic neuromas as there is overall a lower risk than surgery in terms of anesthesia risks, bleeding and infection. Mortality which is a possibility with any brain surgery is extremely rare and even exceptional with modern radiosurgery/stereotactic radiotherapy. In addition numerous centers and clinical papers have documented the safety and effectiveness of Radiosurgery. Newer forms of radiosurgery include Micro-MLC radiosurgery, fractionated radiosurgery (also referred to as Stereotactic Radiotherapy and vice versa) and Proton beam therapy. Combined Microsurgery and Radiosurgery (CMR) is an option that can work well with large acoustic neuromas and schwannomas of the CP angle. Microsurgery is used to remove tumor in a safe way without damaging near by nerves (especially the facial nerve and trigeminal nerve and the brainstem) and any remaining smaller volume tumor is then treated subsequently with radiosurgery / SRT / FSR / Micro (MLC) Radiosurgery. Conclusions: With modern diagnostic methods acoustic neuromas and other cranial schwannomas can be diagnosed earlier when they are smaller and have lesser symptoms and lesser brain and nerve damage. Modern treatment methods including no surgery methods as described above have improved treatment success and allowing more people to have a better quality and length of life.

LATEST CLASSIFICATION FOR BRAIN TUMORS (ADULTS AND CHILDREN) Dr. Prem Pillay, Singapore Senior Consultant Neurosurgeon with super specialty training in Neurosurgical Oncology (Fellow at MD Anderson Cancer Center and Hospital, U of Texas, USA) The 2021 World Health Organization (WHO) Classification of Tumors of the Central Nervous System (CNS), also known as WHO CNS5, represents a significant update in the classification and diagnosis of brain tumors. This fifth edition builds upon the 2016 classification, incorporating new molecular insights and diagnostic approaches. Here is a comprehensive summary of the key changes and features of the latest WHO brain tumor classification: General Changes and Principles Integrated Diagnosis The WHO CNS5 emphasizes the importance of integrated diagnoses, combining histological, molecular, and clinical information. This approach aims to provide more accurate and clinically relevant tumor classifications. Layered Reporting The classification introduces a layered reporting structure, including: Integrated diagnosis Histological classification CNS WHO grade Molecular information This structure allows for a more comprehensive and nuanced understanding of each tumor which allows a better selection of treatment options for patients. Grading System The classification now uses Arabic numerals (1, 2, 3, 4) instead of Roman numerals for tumor grades. Importantly, grading is now done within tumor types rather than across different types. This change aims to better reflect the biological behavior of specific tumor entities. Molecular Diagnostics WHO CNS5 significantly expands the role of molecular diagnostics in tumor classification. Many tumor types now require molecular testing for accurate diagnosis and grading. This is important for a more personalized approach to the treatment of these tumors with potentially better outcomes. Major Changes in Tumor Classification Adult-Type Diffuse Gliomas Astrocytoma, IDH-mutant Grades: 2, 3, or 4 Key molecular markers: IDH1/2 mutation, ATRX loss, TP53 mutation CDKN2A/B homozygous deletion indicates grade 4. Oligodendroglioma, IDH-mutant and 1p/19q-codeleted Grades: 2 or 3 Key molecular markers: IDH mutation, 1p/19q codeletion, TERT promoter mutation. Glioblastoma, IDH-wildtype Always grade 4 Molecular markers for diagnosis: EGFR amplification, TERT promoter mutation, or combined gain of chromosome 7 and loss of chromosome 10. Pediatric-Type Diffuse Gliomas Diffuse astrocytoma, MYB- or MYBL1-altered Angiocentric glioma Polymorphous low-grade neuroepithelial tumor of the young Diffuse low-grade glioma, MAPK pathway-altered. Pediatric-Type High-Grade Gliomas Diffuse midline glioma, H3 K27-altered Diffuse hemispheric glioma, H3 G34-mutant Infant-type hemispheric glioma. Circumscribed Astrocytic Gliomas Pilocytic astrocytoma High-grade astrocytoma with piloid features Pleomorphic xanthoastrocytoma Subependymal giant cell astrocytoma. Glioneuronal and Neuronal Tumors This category includes various entities such as ganglioglioma, dysembryoplastic neuroepithelial tumor, and rosette-forming glioneuronal tumor, among others. Ependymal Tumors The classification of ependymal tumors now incorporates molecular subgroups, particularly for posterior fossa ependymomas . Choroid Plexus Tumors These tumors are now graded within their tumor type, with molecular features playing a role in diagnosis and prognosis. Embryonal Tumors Medulloblastoma : Now classified into molecularly defined subgroups (WNT-activated, SHH-activated, and non-WNT/non-SHH). Atypical teratoid/rhabdoid tumor Embryonal tumor with multilayered rosettes CNS neuroblastoma, FOXR2-activated Molecular Diagnostic Tools The WHO CNS5 classification relies heavily on molecular diagnostic tools for accurate tumor classification. Some key methods include: DNA and RNA Next-Generation Sequencing : For detecting mutations, fusions, and copy number alterations Methylome Profiling : Particularly useful for tumor classification and identification of novel entities. Immunohistochemistry : For detecting protein expression of key molecular markers (e.g., IDH1 R132H, ATRX, H3 K27M) Fluorescence In Situ Hybridization (FISH) : For detecting chromosomal alterations like 1p/19q codeletion Implications for Clinical Practice Multidisciplinary Approach : The integrated diagnosis approach necessitates close collaboration between pathologists, molecular biologists, and Neurosurgeons. Personalized Medicine : More precise tumor classification allows for more targeted therapies and better prognostication and potentially better outcomes. Challenges in Implementation : The increased reliance on molecular testing may pose challenges in resource-limited settings. Ongoing Research : The classification acknowledges that our understanding of CNS tumors is evolving, and future updates are anticipated as new molecular insights emerge. In conclusion, the WHO CNS5 classification represents a significant step towards a more molecularly informed and clinically relevant approach to brain tumor diagnosis. It integrates histological and molecular features to provide a comprehensive tumor classification system that aims to improve patient care through more accurate diagnosis, prognosis, and treatment selection.

Dr. Prem Pillay, Singapore Senior Consultant Neurosurgeon with super specialty training in Neurosurgical Oncology (Fellow at MD Anderson Cancer Center and Hospital, U of Texas, USA) Hydrocephalus in adults is a complex and multifaceted condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain. This condition can result from a variety of etiologies, leading to increased intracranial pressure and subsequent neurological impairment. The management of adult hydrocephalus requires a nuanced understanding of its pathophysiology, clinical presentation, diagnostic modalities, and therapeutic interventions. Etiology and Pathophysiology Adult hydrocephalus can be classified into several categories based on its underlying cause: obstructive (non-communicating), communicating, and ex-vacuo hydrocephalus. Obstructive hydrocephalus arises from a physical blockage within the ventricular system or at the outlets of the fourth ventricle, impeding the flow of CSF. Common causes include tumors, such as colloid cysts , pineal tumors, gliomas including tectal gliomas, and aqueductal stenosis, which may be congenital or acquired due to inflammation or hemorrhage. Communicating hydrocephalus, on the other hand, occurs despite the absence of an obstruction in the ventricular system. It is often attributed to impaired CSF absorption at the arachnoid granulations, which can be secondary to subarachnoid hemorrhage, hemorrhagic strokes, meningitis, or idiopathic normal pressure hydrocephalus (iNPH). Ex-vacuo hydrocephalus is a misnomer, as it reflects ventricular enlargement secondary to brain atrophy rather than true hydrocephalus, and is commonly seen in neurodegenerative diseases such as Alzheimer’s Dementia. Clinical Presentation The clinical presentation of hydrocephalus in adults can vary widely. Symptoms may develop acutely or slowly, depending on the rate of CSF accumulation and the underlying pathology. Classic manifestations include headaches, nausea, vomiting, blurred vision, and papilledema, indicative of raised intracranial pressure. In contrast, iNPH is characterized by a triad of gait disturbance, cognitive impairment, and urinary incontinence, often with normal or only slightly elevated intracranial pressure. Diagnostic Evaluation Clinical findings are supported by imaging studies, which are essential for diagnosis and treatment planning. Computed tomography (CT) and magnetic resonance imaging (MRI) are the primary modalities used to assess ventricular size, identify potential causes of CSF flow obstruction, and evaluate for transependymal CSF flow. MRI provides superior soft tissue contrast and can delineate the anatomy of the ventricular system and surrounding structures in greater detail. Patients with suspected Normal Pressure Hydrocephalus often have a lumbar spine CSF tap to observe any improvement in their symptoms such as gait before having a programable ventriculoperitoneal shunt (VP shunt) placement states Dr Prem Pillay. Treatment The cornerstone of hydrocephalus management is the diversion of CSF to reduce intracranial pressure and alleviate symptoms. Ventriculoperitoneal (VP) shunts are the most commonly employed devices, consisting of a proximal catheter placed within the lateral ventricle, a valve mechanism to regulate flow, and a distal catheter that terminates in the peritoneal cavity. Alternatives include ventriculoatrial (VA) and lumboperitoneal (LP) shunts, which are selected based on patient-specific anatomical and physiological considerations. Endoscopic third ventriculostomy (ETV) is a minimally invasive surgical option for obstructive hydrocephalus, which involves creating an opening in the floor of the third ventricle to allow CSF to bypass the obstruction and flow directly into the subarachnoid space. ETV is associated with lower infection rates and may reduce the need for shunt placement, particularly in patients with aqueductal stenosis or tectal gliomas. Microsurgical removal of tumors obstructing the CSF pathways may also relieve hydrocephalus without needing to place a shunt or do an ETV. Examples of this including removing a large cerebellar tumor that is compressing the fourth ventricle and causing hydrocephalus explains Dr Prem Pillay. Latest and Future Innovations Advancements in neuroimaging, including the development of phase-contrast MRI techniques, are enhancing the ability to visualize CSF dynamics and may lead to improved diagnostic accuracy. The integration of machine learning algorithms with imaging data holds promise for predicting shunt responsiveness and optimizing patient selection for ETV. Neuronavigation with computer aided Image guidance allows the more precise placement of Ventricular shunts reducing bleeding and obstruction. Robotics may also improve the precision of shunt placements. Neuroendoscopic innovations continue to evolve, with the advent of flexible endoscopes and improved intraventricular navigation systems, potentially expanding the indications for ETV and enhancing surgical outcomes. Additionally, the development of programmable shunt valves and telemetric pressure sensors is refining the management of shunt systems, allowing for non-invasive adjustments and monitoring to prevent over- or under-drainage complications. In the realm of molecular biology, research into the pathophysiological mechanisms underlying CSF production and absorption may yield novel pharmacological targets for the treatment of hydrocephalus. Gene therapy and stem cell-based approaches are also being explored as potential avenues for repairing or replacing dysfunctional CSF pathways. Conclusions Hydrocephalus in adults is a condition with diverse etiologies and clinical manifestations, requiring a tailored approach to diagnosis and management. Current treatment strategies focus on CSF diversion through shunting or endoscopic procedures, with ongoing research aimed at improving patient outcomes through technological and biological innovations. As our understanding of hydrocephalus deepens, the future holds the potential for more precise and less invasive therapeutic options explains Dr Prem. With many years of experience in treating hydrocephalus and access to the latest technological advancements, Dr Prem Pillay endeavours to offer patients the highest standard of care. From accurate diagnosis to tailored treatment plans, our approach aims for the best possible outcomes for individuals affected by this challenging condition. If you or a loved one has been diagnosed with Hydrocephalus, we welcome you to seek consultation with our specialist and his team. Together, we can develop a comprehensive evidence based and personalized treatment strategy that addresses your unique needs and provides the best chance for a positive outcome.

What is Back Pain? Back pain is one of the most common health complaints worldwide, affecting people of all ages and lifestyles. It is characterised by discomfort, stiffness, or sharp pain in the back, which can range from mild to severe. While most cases of back pain are not serious and resolve with time, some may be caused by underlying medical conditions requiring further evaluation and treatment. Types of Back Pain Back pain can be broadly categorised into two main groups: mechanical and secondary back pain. Mechanical Back Pain This is the most common type and occurs due to strain or structural issues in the spine. Common subtypes include: Muscle Strain or Ligament Sprain : Often caused by overuse, improper lifting, or sudden movements, leading to pain and stiffness. Herniated Disc : Occurs when the soft cushion between vertebrae bulges or ruptures, pressing on nearby nerves and causing pain or numbness. Degenerative Disc Disease : Age-related wear and tear of spinal discs, leading to chronic pain or limited mobility. Facet Joint Pain : Caused by inflammation or arthritis in the small joints connecting the vertebrae, resulting in localised back pain. Secondary Back Pain This results from other medical conditions or systemic issues, such as: Spinal Stenosis : Narrowing of the spinal canal, leading to nerve compression and pain radiating to the legs. Osteoporosis : Weak, brittle bones that can result in compression fractures of the spine. Infections or Tumours : Rare but serious causes, involving the bones, discs, or soft tissues in the back. Referred Pain : Pain originating from other organs, such as the kidneys or gastrointestinal tract, that manifests in the back. Symptoms of Back Pain The symptoms of back pain vary depending on its type and underlying cause. Common symptoms include: Aching, stabbing, or sharp pain in the lower, middle, or upper back. Pain that worsens with movement, sitting, or standing for prolonged periods. Muscle stiffness or tightness, limiting mobility. Numbness, tingling, or weakness, especially in the legs (common in nerve-related back pain). Pain that radiates to the hips or down one or both legs (sciatica). Warning Signs : Seek immediate medical attention if you experience: Severe pain following an accident or trauma. Persistent pain that worsens over time or disrupts sleep. Neurological symptoms such as weakness, loss of bladder or bowel control, or difficulty walking. Unexplained weight loss or fever accompanying back pain. Diagnosis and Treatment Options Diagnosis: A thorough evaluation is essential to identify the cause of back pain. Diagnostic steps may include: Detailed Medical History and Physical Examination : To assess symptoms, posture, and range of motion. Imaging Studies : X-rays, MRI, or CT scans to detect structural issues, injuries, or abnormalities. Blood Tests : To rule out infections, inflammatory conditions, or other systemic causes. Nerve Function Tests : Electromyography (EMG) to evaluate nerve and muscle function in cases of suspected nerve compression. Treatment Options: Treatment varies depending on the cause and severity of back pain: Lifestyle Modifications : Maintain a healthy weight to reduce strain on the spine. Practice good posture and ergonomics, especially during work or while lifting heavy objects. Engage in regular low-impact exercises, such as walking or swimming, to strengthen the back muscles. Medication : Over-the-counter pain relievers, such as ibuprofen or paracetamol, for mild to moderate pain. Prescription medications, including muscle relaxants or anti-inflammatory drugs, for severe cases. Injections, such as corticosteroids, for inflammation-related pain. Physical Therapy : Tailored exercises to improve flexibility, strengthen the core muscles, and alleviate pain. Manual therapy or spinal manipulation techniques for temporary pain relief. Surgical Interventions : Required only for severe cases, such as herniated discs, spinal stenosis, or fractures that do not respond to conservative treatments. Common procedures include laminectomy, discectomy, or spinal fusion. Alternative Therapies : Acupuncture, massage therapy, or chiropractic care for additional relief. Mindfulness-based stress reduction or yoga to manage chronic back pain. Conclusion Back pain is a common yet diverse condition that can significantly impact your daily life. Understanding the type and cause of your back pain is key to finding the right treatment approach. At Singapore Brain Spine Nerves Center, we offer expert evaluation and personalised treatment plans tailored to your needs. If you or a loved one are struggling with recurring or severe back pain, do not hesitate to seek professional advice. Let us help you regain comfort and mobility. Visit the Singapore Brain Spine Nerves Center today to learn more!

Dr. Prem Pillay, Singapore Senior Consultant Neurosurgeon with super specialty training in Neurosurgical Oncology (Fellow at MD Anderson Cancer Center and Hospital, U of Texas, USA) A new technology to help those with disabilities from Brain damage after a stroke, head injury, brain tumor, brain infection, birth related brain dysfunction and other causes of brain damage The human brain, with its intricate network of neurons and synapses, remains one of the most fascinating and complex systems in the universe. For decades, scientists have dreamt of directly interfacing with this enigmatic organ, unlocking its secrets and harnessing its potential. This dream is now becoming a reality with the rapid advancement of Brain-Computer Interfaces (BCIs). BCIs are devices that translate brain activity into external outputs, enabling communication and control without the need for traditional muscle movements. This technology holds immense promise for individuals with disabilities, allowing them to regain lost function and interact with the world around them in new and exciting ways. Brain-computer interfaces (BCIs) have emerged as a promising technology that allows direct communication between the human brain and external devices. Over the years, significant advancements have been made in the field of BCIs, enabling new possibilities for medical applications, neurorehabilitation, and human-machine interactions. In this article, we will explore some of the recent advances in brain-computer interfaces and their potential implications. Non-Invasive Brain Computer Interfaces: Non-invasive BCIs utilize external sensors to measure brain activity without the need for invasive procedures. Recent advancements in non-invasive BCIs include: High-resolution Electroencephalography (EEG) Improved electrode designs and signal processing techniques have enhanced the spatial and temporal resolution of EEG-based BCIs . This allows for more accurate and reliable detection of brain signals. Functional Near-Infrared Spectroscopy (fNIRS) fNIRS measures changes in blood oxygenation levels in the brain. It offers portability and the ability to monitor deeper brain regions, making it suitable for various applications, including neurofeedback and cognitive training . Invasive BCIs: Invasive BCIs involve implanting electrodes directly into the brain to record neural activity. Recent advancements in invasive BCIs include: Neuralink Elon Musk’s ambitious project aims to implant high-density electrode arrays directly into the brain, enabling seamless communication between humans and computers. Early trials have shown promising results in restoring movement and communication in paralyzed individuals.Paradromics This company in Austin, Texas has developed the highest data rate transfer BCI system using platinum-iridium electrodes thinner than a human hair and are able to pack 1600 of them into a tiny brain module. They plan to help paralysed people move their limbs, and potentially may in the future allow vision for the blind and hearing for those with brain damage.* Synchron This company has developed a minimally invasive BCI that can be implanted under the skin without the need for open brain surgery. The device has been successfully used to treat patients with severe paralysis, allowing them to control prosthetic limbs and communicate through a virtual keyboard.* BrainGate This pioneering BCI system has been used in clinical trials for over a decade, demonstrating the potential for restoring movement and communication in individuals with spinal cord injuries. Recent advancements have focused on improving signal processing and developing more intuitive control interfaces.* Brain-to-Brain Communication Researchers have achieved groundbreaking success in enabling direct communication between two individuals using BCIs. This technology opens up possibilities for collaborative tasks and enhanced social interaction. 3.  Hybrid BCIs: Hybrid BCIs combine multiple modalities to improve the accuracy and reliability of brain signal detection. Recent advancements in hybrid BCIs include: Electroencephalography and Functional Magnetic Resonance Imaging (EEG-fMRI): EEG-fMRI fusion combines the high temporal resolution of EEG with the high spatial resolution of fMRI. This hybrid approach enables more precise localization of brain activity and enhances the understanding of brain dynamics [[2]]( https://www.nature.com/articles/s41378-022-00453-4 ). Electroencephalography and Eye-Tracking Combining EEG with eye-tracking technology allows for more accurate interpretation of brain signals by incorporating gaze information. This hybrid BCI approach has potential applications in human-computer interaction and assistive technologies [[2]] ( https://www.nature.com/articles/s41378-022-00Recent advances in brain-computer interfaces have opened up new possibilities for understanding the human brain, treating neurological disorders, and enhancing human-machine interactions. Non-invasive, invasive, and hybrid BCIs have all seen significant progress, improving the accuracy, resolution, and usability of these interfaces. As research continues, we can expect further advancements in BCIs, leading to more effective and accessible applications in various fields. Recent Advances in BCI Technology: Neuralink Elon Musk’s ambitious project aims to implant high-density electrode arrays directly into the brain, enabling seamless communication between humans and computers. Early trials have shown promising results in restoring movement and communication in paralyzed individuals.Paradromics This company in Austin, Texas has developed the highest data rate transfer BCI system using platinum-iridium electrodes thinner than a human hair and are able to pack 1600 of them into a tiny brain module. They plan to help paralysed people move their limbs, and potentially may in the future allow vision for the blind and hearing for those with brain damage.* Synchron This company has developed a minimally invasive BCI that can be implanted through blood vessels in the head without the need for open brain surgery. The device has been successfully used to treat patients with severe paralysis, allowing them to control prosthetic limbs and communicate through a virtual keyboard. BrainGate This pioneering BCI system has been used in clinical trials for over a decade, demonstrating the potential for restoring movement and communication in individuals with spinal cord injuries. Recent advancements have focused on improving signal processing and developing more intuitive control interfaces. Brain-to-Brain Communication: Researchers have achieved groundbreaking success in enabling direct communication between two individuals using BCIs. This technology opens up possibilities for collaborative tasks and enhanced social interaction. Ethical Considerations: As BCI technology advances, ethical considerations become increasingly important. Issues such as privacy, security, and potential misuse of this powerful technology need careful attention. Open discussions and regulations are crucial to ensure responsible development and implementation. The Future of BCIs: Recent advances in brain-computer interfaces have opened up new possibilities for understanding the human brain, treating neurological disorders, and enhancing human-machine interactions. Non-invasive, invasive, and hybrid BCIs have all seen significant progress, improving the accuracy, resolution, and usability of these interfaces. The future of BCIs is brimming with possibilities. As the technology continues to evolve, we can expect to see even more groundbreaking advancements in the years to come. From restoring lost function to enhancing human capabilities, BCIs have the potential to reshape our understanding of the brain and revolutionize the way we interact with the world around us. This article is just a glimpse into the exciting world of BCIs. As research and development continue, we can expect even more remarkable breakthroughs in this field, pushing the boundaries of human-machine interaction and unlocking the full potential of the human mind. References Learn more:1. [Brain-computer interface: trend, challenges, and threats | Brain Informatics | Full Text]( https://braininformatics.springeropen.com/articles/10.1186/s40708-023-00199-3)2 . [Neuron devices: emerging prospects in neural interfaces and recognition | Microsystems & Nanoengineering]( https://www.nature.com/articles/s41378-022-00453-4)3 . [The year of brain-computer interfaces | Nature Electronics]( https://www.nature.com/articles/s41928-023-01041-8 )

What is a Disc Herniation/Slipped Disc? A disc herniation, often referred to as a slipped or ruptured disc, occurs when the soft, gel-like centre (nucleus pulposus) of a spinal disc pushes through a tear in the outer layer (annulus fibrosus). This displacement can irritate nearby nerves, resulting in pain, numbness, or weakness in the back, neck, or extremities. While herniated discs are more common in the lower back (lumbar spine), they can also occur in the neck (cervical spine) or, rarely, in the upper back (thoracic spine). Types of Disc Herniation/Slipped Disc Disc herniations are classified based on their location and the degree of displacement: Lumbar Disc Herniation: This is the most common type, affecting the lower back. Common symptoms include: Localised back pain. Sciatica, characterised by pain radiating down the leg. Weakness or tingling in the legs or feet. Cervical Disc Herniation: Occurs in the neck region and may cause: Pain radiating to the shoulders or arms. Numbness or weakness in the hands. Stiff neck or reduced range of motion. Thoracic Disc Herniation: Rarely occurring, this type affects the upper back and may lead to: Mid-back pain. Symptoms radiating around the chest or abdomen. Difficulty standing straight or walking due to pain. Stages of Disc Herniation Disc herniation develops in stages based on the severity of damage to the disc: Bulging Disc : The disc protrudes outward but remains intact. Herniated Disc : The inner gel leaks out and presses on nearby nerves. Sequestered Disc : A fragment of the disc breaks off, potentially causing more severe nerve compression. Symptoms of a Disc Herniation The symptoms of a herniated disc depend on its location and the severity of nerve involvement. Common symptoms include: Localised pain in the back or neck. Radiating pain (sciatica) that travels down the leg or arm. Numbness, tingling, or a pins-and-needles sensation. Muscle weakness in the affected area, such as the legs or arms. Reduced range of motion or difficulty with movements like bending or twisting. Warning Signs : Seek immediate medical attention if you experience: Loss of bladder or bowel control (cauda equina syndrome). Severe, sudden pain or weakness. Persistent pain that does not improve with rest or medication. Difficulty walking or maintaining balance. Diagnosis and Treatment Options Diagnosis: A comprehensive evaluation is essential to diagnose a herniated disc accurately. Diagnostic steps may include: Medical History and Physical Examination : To identify symptoms, assess reflexes, and test muscle strength. Imaging Studies : MRI or CT scans to visualise the disc and detect nerve compression. Nerve Function Tests : Electromyography (EMG) to evaluate nerve and muscle activity. Treatment Options: Treatment for disc herniation aims to relieve symptoms, improve mobility, and prevent further damage. Approaches include: Conservative Treatments : Rest and Activity Modification : Avoid strenuous activities that worsen symptoms while maintaining light physical activity. Medications : Over-the-counter pain relievers such as ibuprofen or paracetamol. Prescription medications like muscle relaxants or nerve pain medications (e.g., gabapentin). Physical Therapy : Exercises to strengthen the back and core muscles. Stretching routines to improve flexibility and reduce tension. Advanced Interventions : Epidural Steroid Injections : To reduce inflammation and provide temporary relief. Minimally Invasive Procedures : Microdiscectomy : Surgical removal of the herniated portion of the disc to relieve nerve pressure. Laminectomy : Removal of part of the vertebra to create space and ease nerve compression. Alternative Therapies : Chiropractic care, acupuncture, or massage for symptom relief. Yoga or Pilates to strengthen muscles and improve posture. Surgical Treatments : Surgery is considered for severe cases where conservative measures fail, or if there are complications like nerve damage. Procedures include: Spinal fusion: To stabilise the spine. Artificial disc replacement: In suitable cases, the damaged disc is replaced with a synthetic one. Conclusion A herniated disc can significantly impact daily life, but with the right diagnosis and tailored treatment, most individuals experience relief and a return to normal activities. If you are experiencing back pain, sciatica, or other related symptoms, seek expert medical advice. At Singapore Brain Spine Nerves Centre, our experienced team provides thorough evaluations and personalised treatment plans to help you regain your mobility and comfort. Take the first step towards recovery by scheduling an appointment with us today.

Dr. Prem Pillay, Singapore Senior Consultant Neurosurgeon with super specialty training in Neurosurgical Oncology (Fellow at MD Anderson Cancer Center and Hospital, U of Texas, USA)\ What is the Gamma Knife? The Gamma Knife is a specialized medical device used to treat brain disorders, particularly tumors and other abnormalities. Despite its name, it doesn’t involve any actual cutting. Instead, it uses focused beams of Gamma Rays to target and treat specific areas within the brain. This non-invasive technique is known as stereotactic radiosurgery. The Gamma Knife is highly precise, allowing doctors to treat brain conditions without the need for traditional surgery. Dr Prem Pillay, spearheaded the setting up of the first Gamma Knife Center in Singapore and the Region (South East Asia and South Asia). He currently treats patients with the latest Gamma Knife which uses Robotic assistance. Conditions Treated with Gamma Knife The Gamma Knife is primarily used to treat a variety of brain conditions, including: Brain Tumors Both benign (non-cancerous) such as Meningiomas, Acoustic Neuromas, Pituitary Tumors and malignant (cancerous) tumors can be treated. Arteriovenous Malformations (AVMs) These are abnormal tangles of blood vessels in the brain. Trigeminal Neuralgia A chronic pain condition affecting the trigeminal nerve in the face. Acoustic Neuromas Non-cancerous tumors that develop on the nerve leading from the inner ear to the brain. Metastatic Brain Cancers Cancers that have spread to the brain from other parts of the body such as Lung Cancer, Breast Cancer, Colon Cancer and many other primary cancers. Advantages Over Surgery and Other Treatments The Gamma Knife offers several advantages over traditional surgery and other treatment methods: Non-Invasive There’s no need for incisions, which reduces the risk of infection and other surgical complications. Precision The treatment targets only the affected area, minimizing damage to surrounding healthy tissue. Outpatient Procedure Most patients can go home the same day, avoiding a hospital stay. Minimal Recovery Time Patients typically experience a quicker recovery compared to conventional surgery. Less Painful Since there are no cuts or stitches, patients usually experience less pain and discomfort. Treatment Steps Here’s what a typical Gamma Knife treatment involves: Consultation The process begins with a consultation with Dr Prem Pillay,a Neurosurgeon and Gamma Knife specialist who evaluates whether Gamma Knife treatment is appropriate for your condition. Preparation On the day of treatment, a lightweight frame is attached to your head to keep it still during the procedure. This ensures precision targeting. Imaging Detailed imaging scans (such as MRI and/or CT) are taken to pinpoint the exact location of the area to be treated. Treatment Planning Using advanced software with 3 D modelling of the Brain and the tumor or lesion, Dr Pillay and his team,. plan how to deliver the radiation beams most effectively and safely with high precision. Treatment Session You’ll lie on a bed that slides into the Gamma Knife machine. The machine delivers focused radiation beams to the targeted area in your brain. Robotic assistance is used to improve the accuracy of the treatment. Dr Prem will monitor the treatment from then adjacent control room where muliptle computer screens show the real time dose output of gamma rays and video imaging of the patient. Post-Treatment Once treatment is complete, the stereotactic frame is removed and you can usually return home shortly afterward. Why People with Brain Tumors Should Consider This Treatment Gamma Knife radio surgery is particularly beneficial for individuals with brain tumors and AVMs because it offers an effective alternative to traditional surgery with fewer risks and side effects. It’s especially useful for treating tumors and AVMS in hard-to-reach areas of the brain or for patients who cannot undergo conventional surgery due to health reasons. It is also useful for patients with Trigeminal Neuralgia. Post-Treatment Care After undergoing Gamma Knife treatment, patients should follow these general guidelines: Follow-Up Appointments Regular check-ups with your doctor are crucial to monitor your progress and assess any changes in your condition. Rest and Recovery Although recovery time is minimal, it’s important to rest and avoid strenuous activities for a few days after treatment. Report Symptoms Any unusual symptoms or side effects should be reported to your healthcare provider immediately. Lifestyle Adjustments Depending on your condition, you may need to make certain lifestyle adjustments as advised by your doctor. Conclusion The Gamma Knife represents a significant advancement in treating brain disorders with its precision and non-invasive approach. It offers hope and effective treatment options for those dealing with challenging conditions like brain tumors, AVMs and Trigeminal Neuralgia providing an alternative that minimizes risks while maximizing outcomes.

What is Sciatica? Sciatica refers to pain that radiates along the sciatic nerve, the largest nerve in the body. This nerve runs from the lower back, through the hips and buttocks, and down each leg. Sciatica typically occurs when the nerve is compressed, irritated, or inflamed, causing discomfort that ranges from mild to severe. While most cases are resolved with conservative treatments, some may require further evaluation to address the underlying cause. Types of Sciatica Sciatica can be broadly categorised into two main groups: structural and secondary sciatica. Structural Sciatica This is the most common type, caused by physical issues that compress or irritate the sciatic nerve. Common subtypes include: Herniated Disc : A common cause of sciatica, where a bulging or ruptured spinal disc presses on the sciatic nerve. Spinal Stenosis : Narrowing of the spinal canal, leading to compression of the nerve roots. Piriformis Syndrome : Irritation of the sciatic nerve caused by the piriformis muscle in the buttocks. Spondylolisthesis : A condition where a vertebra slips forward over the one below it, narrowing the spinal canal and pinching the sciatic nerve. Secondary Sciatica This occurs as a result of other conditions or factors that indirectly affect the sciatic nerve. Examples include: Pregnancy : Pressure from the growing uterus on the sciatic nerve. Tumours : Rare but serious causes that may compress the sciatic nerve. Trauma or Injury : Direct injury to the nerve or surrounding tissues. Systemic Conditions : Conditions such as diabetes can lead to nerve damage (diabetic neuropathy), including the sciatic nerve. Symptoms of Sciatica The symptoms of sciatica may vary in intensity and presentation, depending on the cause. Common symptoms include: Radiating pain from the lower back through the buttocks and down the leg. Sharp, burning, or shooting pain that worsens with movement, coughing, or sneezing. Numbness, tingling, or "pins and needles" sensation in the leg or foot. Muscle weakness in the affected leg. Difficulty sitting, standing, or walking for prolonged periods. Warning Signs : Seek immediate medical attention if you experience: Severe pain accompanied by weakness, numbness, or difficulty moving the leg or foot. Loss of bladder or bowel control (a rare condition called cauda equina syndrome). Persistent, worsening pain that does not improve with rest or conservative treatments. Diagnosis and Treatment Options Diagnosis: A comprehensive evaluation is essential to determine the underlying cause of sciatica. Diagnostic steps may include: Detailed Medical History and Physical Examination : To assess symptoms, reflexes, and mobility. Imaging Studies : X-rays, MRI, or CT scans to identify structural issues such as herniated discs or spinal stenosis. Electromyography (EMG) : To assess nerve function and pinpoint areas of nerve compression or damage. Treatment Options: The treatment of sciatica focuses on relieving pain and addressing the root cause. Options include: Lifestyle Modifications : Regular low-impact exercises, such as swimming or walking, to improve flexibility and strength. Ergonomic adjustments at work or home to reduce strain on the lower back. Weight management to minimise pressure on the spine. Medication : Over-the-counter pain relievers, such as paracetamol or ibuprofen, for mild symptoms. Prescription medications, including muscle relaxants or anti-inflammatory drugs, for more severe cases. Nerve block injections or corticosteroids to reduce inflammation around the sciatic nerve. Physical Therapy : Specific stretches and strengthening exercises tailored to relieve pressure on the sciatic nerve. Manual therapy to reduce muscle tension and improve mobility. Surgical Interventions : Reserved for severe cases where conservative treatments have failed, such as for a herniated disc or spinal stenosis. Common procedures include microdiscectomy or laminectomy to relieve nerve compression. Alternative Therapies : Acupuncture or chiropractic care to alleviate pain and promote healing. Yoga and mindfulness-based stress reduction to manage chronic symptoms. Conclusion Sciatica can significantly impact daily life by limiting mobility and causing persistent discomfort. Understanding the underlying cause of your symptoms is crucial for effective treatment. At Singapore Brain Spine Nerves Center, we provide expert evaluation and personalised care to help you recover and regain your quality of life. If you or a loved one are struggling with sciatica, schedule a consultation with us today to take the first step toward lasting relief. Visit the Singapore Brain Spine Nerves Center to learn more.

What are Cervical Radiculopathies? Cervical radiculopathies, often referred to as a "pinched nerve," occur when a nerve in the neck is compressed or irritated as it exits the spinal cord. This condition leads to pain, numbness, tingling, or weakness that radiates from the neck into the shoulders, arms, or hands. While it can affect people of all ages, cervical radiculopathy is more common in middle-aged adults due to age-related changes in the spine or in younger individuals following a neck injury. Types of Cervical Radiculopathies Cervical radiculopathies are classified based on their underlying causes and location within the cervical spine: Degenerative Causes : Herniated Disc : A common cause in younger adults, where the cushion-like disc between vertebrae bulges or ruptures, compressing a nearby nerve. Cervical Spondylosis : Age-related wear and tear of the spine, leading to bone spurs and narrowing of the nerve passageways (foramina). Spinal Stenosis : Narrowing of the spinal canal or foramina, compressing the nerve roots. Traumatic Causes : Injury : Trauma to the neck, such as whiplash, can cause inflammation, misalignment, or disc damage that affects the nerves. Systemic or Rare Causes : Infections : Such as shingles, which can inflame the nerve roots in the cervical spine. Tumours : Rarely, abnormal growths within or near the spine can compress cervical nerves. Autoimmune Conditions : Diseases like rheumatoid arthritis may contribute to cervical radiculopathy. Symptoms of Cervical Radiculopathies The symptoms of cervical radiculopathies depend on the specific nerve affected and the severity of compression. Common symptoms include: Radiating Pain : Sharp or burning pain that travels from the neck to the shoulder, arm, or hand. Numbness or Tingling : Often felt in the fingers or along specific areas of the arm, corresponding to the affected nerve root. Muscle Weakness : Difficulty gripping objects or performing fine motor tasks, such as buttoning a shirt. Neck Stiffness : Pain that worsens with neck movements, such as turning or tilting the head. Reflex Changes : Altered or diminished reflexes in the arms or hands. Warning Signs : Seek immediate medical attention if you experience: Severe, worsening pain that does not improve with rest or conservative treatment. Weakness or loss of sensation in multiple limbs. Loss of bladder or bowel control, which may indicate a more serious spinal condition. Diagnosis and Treatment Options Diagnosis: A thorough evaluation is crucial to pinpoint the cause and severity of cervical radiculopathy. Diagnostic steps may include: Medical History and Physical Examination : To assess symptoms, reflexes, and muscle strength. Imaging Studies : MRI or CT scans to visualise nerve compression, herniated discs, or bone spurs. Nerve Conduction Studies : To test the function of the affected nerve and identify areas of damage. X-rays : To assess alignment and detect signs of arthritis or bone abnormalities. Treatment Options: The treatment for cervical radiculopathies aims to relieve pain, reduce nerve compression, and restore function. Options include: Lifestyle Modifications : Avoid activities that exacerbate neck strain, such as heavy lifting or prolonged computer use. Use ergonomic equipment to maintain proper neck posture. Medications : Over-the-counter pain relievers, such as ibuprofen or paracetamol, for mild symptoms. Prescription medications, including muscle relaxants or nerve pain relievers like gabapentin. Corticosteroid injections to reduce inflammation around the affected nerve. Physical Therapy : Targeted exercises to strengthen neck and shoulder muscles, improve posture, and reduce nerve irritation. Manual therapy or cervical traction to relieve pressure on the nerve roots. Surgical Interventions : Recommended for severe cases where conservative treatments fail. Procedures such as discectomy, laminectomy, or spinal fusion aim to decompress the affected nerve and stabilise the spine. Alternative Therapies : Acupuncture or chiropractic adjustments for additional symptom relief. Yoga or mindfulness-based exercises to manage chronic pain and improve neck flexibility. Conclusion Cervical radiculopathies can significantly impact daily activities, causing pain and functional limitations. Early diagnosis and a tailored treatment plan are essential for effective recovery and to prevent further complications. At Singapore Brain Spine Nerves Center, we specialise in diagnosing and managing cervical radiculopathies, offering personalised care to help you regain comfort and mobility. If you are experiencing persistent neck or arm pain, numbness, or weakness, contact us today to schedule a consultation and take the first step towards relief.

What are Spinal Cord Tumours in Children? Spinal cord tumours in children are abnormal growths that develop within or around the spinal cord. These tumours may be benign (non-cancerous) or malignant (cancerous) and can interfere with the normal functioning of the spinal cord and nerves. Although they are relatively rare, spinal cord tumours in children require prompt evaluation and treatment to prevent complications such as nerve damage, developmental delays, and paralysis. Types of Paediatric Spinal Cord Tumours Paediatric spinal cord tumours are classified based on their location and nature: By Location Intramedullary Tumours : These develop within the spinal cord itself and are often caused by tumours such as astrocytomas or ependymomas. Intramedullary tumours are the most common type in children. Extramedullary Tumours : These occur outside the spinal cord but within the surrounding protective layers (meninges) or spaces. They can compress the spinal cord and include tumours such as meningiomas or schwannomas. By Nature Benign Tumours : These are non-cancerous and grow slowly, often remaining confined to a single area. Examples include lipomas and some types of schwannomas. Malignant Tumours : These are cancerous and can grow aggressively, potentially spreading to other parts of the body. Examples include certain ependymomas or metastatic tumours from other primary cancers. Symptoms of Spinal Cord Tumours in Children The symptoms of spinal cord tumours in children depend on the location, size, and rate of growth of the tumour. Common symptoms include: Back or Neck Pain : Persistent pain that may worsen at night or with activity. Weakness or Numbness : Reduced strength or sensation in the arms or legs. Difficulty Walking : Problems with balance or coordination. Loss of Bladder or Bowel Control : Symptoms such as incontinence or difficulty urinating. Spinal Deformities : Visible curvature of the spine or abnormal posture, often due to tumour growth. General Symptoms : Fatigue, weight loss, or decreased appetite may indicate more serious cases. Diagnosis and Treatment Options Diagnosis: Accurate diagnosis is crucial for planning appropriate treatment. Steps typically include: Imaging : MRI is the gold standard for visualising spinal cord tumours and determining their size, location, and characteristics. CT scans may be used to assess bone involvement or abnormalities. Neurological Examination : A detailed assessment of motor, sensory, and reflex functions to identify nerve or spinal cord compression. Biopsy : In some cases, a sample of the tumour may be taken to confirm its type and whether it is benign or malignant. Treatment Options: Treatment for spinal cord tumours in children is tailored to the type, size, and location of the tumour, as well as the child’s overall health. Options include: Observation : Small, benign tumours that are not causing symptoms may be monitored with regular imaging. Surgery : Surgery is often the first line of treatment to remove as much of the tumour as possible. Complete removal is ideal, but in some cases, tumours near critical structures may require partial removal. Radiotherapy : Used for malignant tumours or cases where complete surgical removal is not possible. Advanced techniques like stereotactic radiosurgery (SRS) minimise damage to healthy tissues. Chemotherapy : Particularly useful for malignant or recurrent tumours, chemotherapy may be used alone or in combination with other treatments. Rehabilitation : Physical therapy and occupational therapy help children regain strength, mobility, and independence after treatment. Conclusion Spinal cord tumours in children, while rare, require timely and specialised care to prevent long-term complications. Early detection, accurate diagnosis, and tailored treatment plans can significantly improve outcomes. At Singapore Brain Spine Nerves Center, we provide comprehensive care for paediatric spinal cord tumours, ensuring your child receives the best possible treatment in a supportive environment. For more information or to schedule a consultation, contact us today.

Dr. Prem Pillay, Singapore Senior Consultant Neurosurgeon with super specialty training in Neurosurgical Oncology (Fellow at MD Anderson Cancer Center and Hospital, U of Texas, USA) Historical Origins Robotics in neurosurgery represents a groundbreaking technological advancement that began in 1985, marking the first practical application of robotic systems in surgical procedures[1]. The Zeiss MKM Robotic Microscope and the Surgiscope in the early 2000-2010 period were also groundbreaking. The field has since evolved dramatically, driven by the need for increased precision, minimally invasive techniques, and enhanced surgical capabilities. Types of Robotic Systems Surgical Control Approaches Neurosurgical robotic systems can be categorised into three primary control methods: Surgeon Supervised Systems Preplanned surgical procedures Neurosurgeon plots robotic arm movements beforehand Robot performs predetermined movements NeuroSurgeon provides direct oversight[1] Telesurgical Robots NeuroSurgeon controls surgical movements remotely Real-time control from a separate console Includes haptic feedback and live video transmission Enables surgery from outside the operating room[1] Shared Control System Collaborative interaction between robot and Neurosurgeon NeuroSurgeon maintains primary movement control Robot provides stabilizing forces[1] Notable Robotic Neurosurgery Platforms and Systems Advanced Robotic Systems include: NeuroArm: First MRI-compatible neurosurgical robot (launched 2008) ROSA ONE Brain: Provides minimally invasive brain procedures Renaissance Robotic System: Offers high dexterity for deep brain procedures CyberKnife: Pioneering radiosurgery platform[1][2][3] NDR Spine Robotics for Discoplasty and other Spine procedures Robotic Radiosurgery for Brain and Spine Tumors and Cancers Da Vinici Robotics for selective Brain and Spine Surgery Clinical Applications and Primary Neurosurgical Uses Robotic systems excel in several critical neurosurgical domains: Precise Anatomical Localation Stabilizing Surgical Instruments Deep Brain Target Access Spinal Pedicle Screw Placement Stereotactic Procedures Minimally Invasive Brain Interventions[3][4] Specific Procedural Applications Epilepsy surgery Deep brain stimulation Stereotactic biopsies Electrode placement Tumor removal Laser ablation procedures[4] Technological Advantages Key Benefits Unprecedented Precision: Sub-millimeter accuracy Minimally Invasive Techniques Reduced Surgical Trauma Shorter Procedure Times Lower Infection Risks Enhanced Surgical Planning[2][4] Limitations and Ethical Considerations Technical Challenges Potential view obstruction during surgery Limited tactile dexterity Image acquisition distortions Mechanical design constraints[5] Ethical Concerns Potential reduction in surgeon’s manual skills High technological costs Unequal global access to advanced technology Risk of over-reliance on robotic systems[5] Future Perspectives and Emerging Trends Machine Learning Integration Enhanced Autonomous Capabilities Improved Human-Robot Collaboration Expanded Procedural Applications More Sophisticated Sensory Feedback[6] Future Trends in Robotics in Neurosurgery Neurosurgical robotics is expected to become increasingly sophisticated, with potential multi-robot systems collaborating during complex procedures. The future likely involves more nuanced, adaptive robotic platforms that can handle intricate neurological interventions[6]. Dr Prem Pillay believes that future neurosurgical teams will include humanoid robotic assistants ( AI embodied) working with human Neurosurgeons using smart tools to remove brain tumors and brain cancers; correct spinal problems, and using finer tools and devices to replace diseased, injured or missing parts of the nervous system (Brain and Spinal Cord). Robotic neurosurgery represents a transformative technological frontier, balancing remarkable precision with ongoing technological challenges. As research continues, these systems promise to revolutionize neurological interventions, offering unprecedented surgical capabilities while maintaining critical human expertise. Citations: [1] https://pmc.ncbi.nlm.nih.gov/articles/PMC11588608/ [2] https://www.escatec.com/blog/9-leading-companies-developing-robotic-neurosurgery-technology [3] https://pmc.ncbi.nlm.nih.gov/articles/PMC9479589/ [4] https://www.seattlechildrens.org/clinics/neurosciences/services/robot-assisted-neurosurgery/ [5] https://www.int-res.com/articles/esep2021/21/e021p025.pdf [6] https://thejns.org/focus/view/journals/neurosurg-focus/42/5/article-pE1.xml [7] https://www.zimmerbiomet.com/en/products-and-solutions/zb-edge/robotics/rosa-brain.html [8] https://jnis.bmj.com/content/10/1/78