Pune recently hosted the 3rd National Conference of the Society of Stereotaxy and Functional Neurosurgery on Oct.9 and 10. I think it went off very well and we had interesting lectures, discussions and my impression was that all our guests were happy with the academic fare, the hospitality and the efficiency. I must say Dr. Vhora, as Secretary, did a fine job.
But this is only a prelude. What struck me through the Conference was the way medicine moves forward. The major thrust of stereotaxics surgery is of course the advances in the treatment of Parkinson’s and we will use this disease to speak about how medicine moved forward in the last half century.
- First there is the luck factor – It started in the 50s. Dr.Cooper, a surgeon, was operating on a Parkinson’s patient with an aneurysm. The aneurysm ruptured and he was forced to clip the vessel blind and clipped the anterior choroidal artery. Suprise surprises ! when the patient was awake the SAH was treated and the Parkinsonian tremor had disappeared. Lady luck had stepped in.
- Then the introspection – As is has been said before, many people stumble on the truth, but most just grumble a bit at the fool who left the stone in the way, and go on their way. Cooper paused to think over the chance finding why this luck had occurred. He wondered why that should be, and not getting a good explanation he decided to try his luck and see what happens in other patients of Parkinsonism if he did the same and he was reasonable successful. The surgical treatments of Parkinson’s had begun.
- The third is technology – Neurology and innovation entered. Why not make the same lesion produced by occlusion of the anterior choroidal in a different non invasive way? This gave birth to Stereotaxy. The formation of the Leskell frame the wedding of technology and a dedicated medical man so that using 3 planes, sagittal, coronal and axial and a rotating arm, we could introduce a probe through the skull to hit a predetermined area round 3 mm’s cube in the depth of the brain without incision of injuring superficial areas. As far as I know, it was the first such procedure in any discipline in medicine.
- Then we advanced by accumulating experience – Stereotaxic ablation of the ventral intermediate nucleus of the thalamus became one of the treatments of Parkinson’s in the 50s. Many surgeons all over the world started using the technique. The biggest centre in India was undoubtedly Ramamurthy’s Dept. in Madras, and before that the surgical unit in Vellore. Mumbai started a little later and by the time I had passed, things had crystallized. Stereotaxy was good for tremor predominant Parkinson’s. You required a relatively young patients whose main problem was tremor and who had predominantly unilateral disease. If that were so, he was markedly improved by the stereotactily placed lesion in the thalamus. But bilateral surgery was not desirable and if the problem was bilateral, Stereotaxic surgery was dangerous, it often worsened the patients and caused dysphonia and aphasia.