“Mars is waiting to be reached.”
Buzz Aldrin
My friends,
Today Tiresias would like to put forward a provocative question – Is much of current oncological neurosurgery for malignant brain tumours a sham?
Wow! Wow, you say again. Of course, it's not, you think. Look at the performance. Look at the theatre of it all on television. Check out the drama. Look at all those lights. The costumes too! The supporting cast. The machines, the scanners, the rituals. The costs. The costs!But then look at the results. The prognosis for malignant astrocytoma has not changed in 60 years. Why? Because it misses point. It’s “Cargo Cult Medicine”. As Tiresias said before, despite all the machinery and technology cancer neurosurgery is quite a primitive craft. The essential fact is that there is no demarcation, there is no capsule, there is no way that the neurosurgeon using current technology can tell if he is removing normal brain or malignant brain. The current scanners underestimate the distribution of the penumbra of infiltrating invisible cancer cells. These malignant cells are always left behind and which always grow and kill the patient. So, what are these neurosurgeons doing? Why are they doing it? Well to get some tissue, they say. To make the diagnosis? Yes, that is necessary, just in case the tumour is not actually a tumour. That’s the conventional wisdom anyway. So, they open the skull; dig through the brain; diathermy the bleeders; clip a little piece brain tissue; send it off for frozen section; wait, twiddling their fingers whilst the histopathologist looks at the frozen section and mumbles some indefinite possibilities, complaining about the sample and the freezing artifact that such and such could be malignant or it might not be, and can they have another sample. The neurosurgeon curses, these days under his breath. "De-bulks" some more i.e. sucking out some more brain, stops the bleeding, closes up and comes out. Next day; “we got it all”, but just in case, have some radiotherapy and chemo, and the medical oncologist and the radiotherapist take their turn to fund their Porsches. Within 6 to 12 months the tumour regrows. This is not the way. There is only one answer to this, and it surely is taking too long be put in place. CLE; Confocal Laser Endomicroscopy; Optiscan Imaging; in-vivo real-time intraoperative digital cellular histopathology. TINA,(there is no alternative). If they do not remove the malignant cells, they have done nothing. Why are we waiting?
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