Can Innovation In Surgical Technology Change The Outcomes For Gunshot Patients?
Oct 23, 2019 09:43
Gunshot injury is one the most frequent causes of penetrating brain injury. Mortality rates for surviving such a gunshot injury are painting a dark picture: between 52 and 95% do not survive the surgical treatment. Unfortunately, cases of cranio-cerebral gunshot injuries are now more and more frequent on surgeons’ operating tables from all around the world.
A penetrating brain injury wound occurs when the bullet or any other projectile ruptures the cranium but does not exit it. The lives of those who survive such an injury is very much time dependent. The medical standard involves aggressive resuscitation upon hospital arrival and if proper oxygenation to the brain is maintained, surgery.
There are a number of surgical procedures that can be performed, conventionally craniotomy and craniectomy are the main options. Both involve temporarily removing a piece of the skull to take out the projectile, the difference being that when the latter is performed, the bone fragment is not immediately put back into place to help relieve pressure from within the skull.
While there are many theories to suggest one is superior to the other and exactly because there are a number of implications, variables and factors to consider, this is the point where various neurosurgeons part ways when it comes to course of treatment. Could innovation in technologies such as image guided surgery systems help them reach a consensus? It just might.
Firstly, it is important to understand that the wide range of neuro-imaging modalities used in patients with penetrating brain injury plays a vital role in the overall success of the procedure. It helps to guide and inform the type and nature of surgical solution, the size and placement of the incision, and the best route for extracting the bullet. It goes without saying that beyond the surgeon’s capabilities, the life of the patient relies on accuracy.
Cutting-edge image guided surgery systems have the potential to empower neurosurgeons with superior control in an easy and quick way. Machine-vision enables accurate cranial navigation in a snap of fingers by flashing directly into the skull and allowing for effortless focus into the area of interest. This is game-changing for survivors of head trauma gunshot victims. Often neurosurgeons have to decide whether if the best course is to remove the bullet or not and if so, how to proceed. There are manifolds to making this decision and every single second that passes can make the difference between life and death. Equipping them to have a comprehensive picture is therefore crucial.
Secondly, to date, infections are the most frequent local complications and they are caused by leftover metallic fragments. Effective and complete removal of the bullet and any debris can avoid wound contamination, however conventional equipment often fail to capture everything. And again there is a matter of life and death. No one wants a situation where an extremely complex brain surgery is successful, only to be impacted by complications that could have been avoided.
Thirdly, when operating in a conventional way, the brain scans are evaluated prior to the actual intervention and a surgeon needs to use landmarks to guide their way inside the skull. However, when the bullet or debris are removed, it can cause tissues to shift around which poses a whole new set of challenges.
By using an image guided surgery system, the neurosurgeon can reach the bullet and any debris with accurate and pre-calculated precision from any point outside the skull. Therefore improving the surgical approach with less discomfort and risks.
The first and only Machine-vision Image Guided Surgery platform has hit markets and its proprietary Flash™ of light approach leverages the power of over 300,000 points and advanced cranial software algorithms to create digitized cranial registrations almost instantaneously. Neurosurgeons already using the technology have praised the many benefits that come with and foremost, the ability to better respond to the main challenges that come with performing incredibly complicated and detailed procedures.
It is encouraging and motivating to consider the implications such an innovation can have for those patients out of the 95% who reach the operating table with a chance at life. Incredible strides in science and technology needs to be embraced in order to fulfil its full potential and every neurosurgeon should be provided the necessary tools to fulfil theirs. The past two decades have continued to evolve the treatment of penetrating gunshot brain injuries and with every advancement, the outcomes have been pushed forward. Image guided surgery is the next one.
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