St. Petersburg, Russia: A letter from Professor A.S.Iova, Chief of Pediatric Neurosurgery, St. Petersburg Medical Academy of Postgraduate Studies

Minimally invasive neurosurgery (MIN) is one of the significant fields of the modern neurosurgery. It is aimed to reduce the impact of surgeries on patients. The equipment, which is utilized for these purposes, is very complex and expensive. Because of that it is difficult to use these techniques in the everyday practice of elective, urgent, military and catastophic medicine. The prospective of utilization of MIN technologies for pediatric neurosurgery are based on two reasons. First of all, the child's brain is very susceptible to injury, so the principles of MIN are really attractive for children, especially of young age. The other reason is that the traditional MIN technologies were not designed specifically for children, especially for infants and newborns.

The objective of this letter is the discussion of the measures, which may be helpful to widespread the MIN techniques in the everyday practice of the pediatric neurosurgery. MIN techniques have to be independent of: · the medical conditions (elective, urgent, military or catastrophic medicine) · the social welfare of the regions (must to be affordable for very poor regions) · the patient's age (infants and children of a very small age have to be included).

To achieve this aim it is necessary to solve the following problems:

1. theoretical substantiation of the reasons and peculiarities of portable technologies in pediatric neurosurgery

2. elaboration and approval of multi-purpose portable neurosurgical system, which allows: a) the brain examination · on all stages of surgery (before, during and after it) · in a real-time regime · bringing the device to the patient · intraoperative neuronavigation (including stereotactic navigation); b) performance of all main neurosurgical procedures (including microneurosurgery and neuroendoscopy); c) information support of a neurosurgeon on the all stages of diagnostic and surgical treatment (including the Internet resources)

3. choosing of optimal ultrasound diagnostic devices for the transcranial and transcortical sonography and also for ultrasound stereotactic navigation

4. investigation of optimal conditions for employment of multi-purpose portable neurosurgical system in different regions (working out the regional models)

5. development of mechanisms of wide introduction of new technologies (new models of neurosurgical care organization, organization of training center, the teaching literature)

This project is under construction by St.Petersburg Medical Academy of Postgraduate Education and the international organization Neurosurgery International. At the present time we have done the theoretical substantiation of the new MIN model, finished the development of the second version of portable neurosurgical system, done 200 operations with the help of the first version of this system, organized the initial pool of neurosurgical information support (the 1st version), organized the training center for ultrasound diagnostic techniques of brain lesions and Internet consulting center, started organization of the neurosurgical training center. Realization of this program will create the conditions for wide MIN techniques introduction into the everyday practice of pediatric neurosurgery.