The decade began with tangible advances: each of these six tools changed something real, and none of them decides on its own. What was disruptive, however, was not the equipment. It was the reach of information and the growth of knowledge: the trials, their figures, their limits and who funded them are now available to anyone as never before. All six articles cite their sources.
What comes next is not a better version of these tools: it is a change in kind. That is in The future.
The navigation system tells you where the tumour is to within millimetres. The problem is that the brain, the moment the dura is opened, stops being where the image says it is.
Read the article →The patient drinks a compound and the tumour glows pink under violet light. Almost everything that glows is tumour. The problem is everything that does not glow.
Read the article →It replaces the microscope's eyepieces with a screen the whole theatre can see. It improves posture, matches operating times and changes no patient outcome. That last point is not a criticism: it is the question nobody asked.
Read the article →An MRI inside the operating room confirms whether tumour remains. It doubles the rate of complete resections, adds an hour and a half to the procedure, and in the largest trial it nearly doubled intracranial infection. And in more than half of cases, the surgeon does not go back in.
Read the article →Electrodes that watch the spinal cord and the nerves while you operate, and warn before a manoeuvre damages them. It detects poorly — four in ten deficits escape it — and rules out very well. And there is no randomised trial evaluating it, nor will there be.
Read the article →Link by link, this is what artificial intelligence actually does today along a neurosurgical patient's path. The pattern repeats: where it measures well, it measures speed. And the two most honest systems here are the ones that abstain.
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