Innovations are of great help in the field of neurosurgery- Interview with Dr László Lehner, DVM (Part 2)

Only you perform specific operations in Hungary. What are these special fields and surgeries?

One thing I would like to highlight is hypophysectomy, i.e. the surgical removal of the hypophysis usually done due to a cancerous change in the gland. This operation is difficult because the area at issue can only be accessed through the mouth. There are solely 4-5 people in the world who carry out such operations in the field of small animal medicine. There is another surgery that only we do for now, as we brought over this exploration technique from human medicine. In the brain, in the lateral ventricles there are tumour types which can only be removed by the transcallosal approach. A good friend of mine, Dr. Gábor Nagy, works at the Neurosurgery Institute in Amerikai Road in Budapest. He is an excellent human neurosurgeon who showed us these techniques. Nobody operated these tumours in small animals earlier. Of course, we also publish these cases in international journals.

Does this mean that you also have foreign patients with such problems?

Yes, we have had patients from abroad. They mostly come from neighbouring countries, Austria, Romania, Slovakia, etc. Some time ago I had an American patient as well. Interestingly, the owner made a financial decision as these operations are so much cheaper in Hungary that it was worth flying here.

You mentioned that you transfer some techniques from human to veterinary medicine. Similarly, LimesVet started to introduce 3D technology into veterinary medicine. Does it always happen in this way?

Although regulations are stricter now, there used to be - and maybe there are still - loads of operations which were first tested on animals, primarily on swine. Examples include heart valve implants and angioplasty. When these surgeries were successful on animals, doctors started to apply them in human medicine too. So, sometimes it is the other way round. I’m specialised in neurosurgery. It is a fact that human neurosurgery is far ahead of veterinary neurosurgery. Therefore, we learn from them a lot, even different exploration methods. However, we can’t adopt each human surgical exploration method because we can’t use them to remove a similar tumour from a dog or a cat due to their completely different anatomy from people. We simply can’t access it that way. So, there are limitations. We can’t adopt everything. But if chances are that it can work, it is worth trying it.

Are human doctors open to share their experience with veterinarians, or do you have to follow professional journals to see what new techniques are available?

It depends on the person. Of course, it’s simpler to read the literature. You can also find drawings and photos of various procedures in them. It’s, however, not the same when you can also do it.  It seems to be much simpler on paper than it actually is. So, I think it is better to learn it from someone who has experience in these methods. I know a lot of human doctors who are open to cooperate. When we get in touch with human colleagues, we often feel that, at the end of the day, our professions stand very close to each other. Lots of human doctors think we are their colleagues with the difference that we treat animals.

By the way, cooperation. You also work on innovations together with LimesVet. Your experience is valuable. How did this cooperation start?

These innovations help us to a great extent, whether it is spinal or brain surgery. Visualisation, cranioplasty, spinal stabilisation, special implants, drilling guides, etc. They are of great help for surgeons because they make our work easier and faster, and at the same time, there are less complications. Our cooperation started around 2018 when I contacted Dr. Kálmán Czeibert to help me with my first hypophysectomy. His anatomy knowledge is simply outstanding. Later, we also cooperated by a case of cranioplasty, when he helped me with 3D printing and planning as well. And then, when they started to work on innovations under the auspices of LimesVet, they brought their whole built-out system making these surgeries much simpler, easier and more organised. Earlier you had to go to 3-4 places before being able to purchase an implant. Let me give you an example. A dog’s neck vertebrae were not sufficiently stable due to her spinal disease. As a result of this, when she bent to look down or she looked up, her vertebrae moved slightly causing serious pain and consequent movement problems. So, that’s what we needed to stabilise with a special, custom made implant. Again, it was Kálmán, who helped a lot. Based on the CT image he planned the position of the screws and designed the implant. The drilling guides were printed and we received the custom implant matching the anatomy of the animal. That’s how we could achieve the right result.

Thinking about the future, what breakthroughs can you expect in your field?

What is available now is also a huge help. In vertebral medicine custom implants and in brain surgery 3D visualisation and printable, physical guides - the faithful representations of specific brain areas - contribute to the precision and success of operations greatly. The next step can be the adoption of stereotactic surgeries already applied in human medicine. If I go really science fiction, I think VR assisted operations are also feasible. Doctors could see the tiniest vessels through VR headsets. Nothing to tell about robotics. These technologies could make complex surgeries much safer and more precise.

The first part of the interview can be read here.