BBC TOMORROW'S WORLD

Peter Snow: Hello. Welcome to the future and brain surgery for the 21st century.

Philippa Forrester: This is a neurological endoscope. There you are. That's what you can see through it - a lovely shot of Mr. Snow beaming down it. It's one of a range of tools that's making new types of brain surgery possible. It's part of the modern brain surgeon's kit, but this ... little tiny fleck is the same stuff that makes your nonstick sauce pans easy to wash up, and that could end up deep inside someone's brain.

Peter: We're about to witness an astonishing operation by a pioneering team in California, which makes use of all the latest equipment. Katie Nappman is off to meet the patient, and we should warn you, we share the operation in detail from the start.

Katie: Amazing images of the brain like these are something we're all use to seeing, but now the use of endoscopes in surgery are giving surgeons a front row opportunity - to look at the living human brain from right inside the skull.

Katie: It's a breakthrough that patients like Ron Adams could benefit from. Ron has a nerve trapped at the base of his brain and for four years, he's been in excruciating pain. In two day's time, he's having an operation that he hopes will change his life.

Katie: Hello.

Ron: Hello.

Katie: Nice to meet you, at last.

Ron: Nice to meet you.

Katie: The medication he's taking just to survive each day is draining him of energy.

Ron: When I get home, I'm completely exhausted - feed the dogs, go in, take a shower, eat dinner and fall asleep ... probably by 7:30.

Katie: The whole condition's put a terrible strain on his family.

Rita Adams: He's not the same person that he used to be. He's...um...much more...much quieter than he use to be. He...um...isn't as affectionate as he used to be. And he...it's hard for him, it really is. And it's hard for me to see him hurting all the time.

Ron: It seems to emanate from this tooth here and in, but it goes all the way up the jaw and down into here, and it's a sh...it's a sharp shooting, stinging pain.

Rita: He can't kiss me like he use to kiss me. It's just a little peck, or...a...like...a...just...a...touch on the cheek. And I would like to just be able to have him kiss me right again, you know, a real kiss.

Katie: At the Skull Base Institute, in the CS Hospital in Los Angeles, Dr. Hrayr Shahinian is planning to operate on Ron with the new endoscopic technique.

Dr. Shahinian: Ron Adams has a condition called trigeminal neuralgia. It's also known as the most painful affliction that humans get. It is more painful than kidney stones, more painful than broken bones.

Katie: Such extreme pain comes from a blood vessel, which is wrapped around Ron's trigeminal nerve at the base of his skull.

Dr. Shahinian: And if you look here, you can see a black structure here. That's the blood vessel sitting very close to the trigeminal nerve.

Katie: In this cross-section, we've colored the blood vessel red. It's growing painfully close to the nerve.

Dr. Shahinian: And it's pulsating. It's whipping the nerve at 80 beats a minute.

Katie: Separating a blood vessel from a nerve like this has been classically done by surgeons peering into the head through a small hole, using a microscope. But tomorrow, Dr. Shahinian will get an even closer view of the nerve using an endoscope. It's a risky procedure.

Dr. Shahinian: Damage to the brain is a possibility, a...a stroke is a possibility, a...infection inside the head known as meningitis is a possibility.

Katie: Dawn on the day of the operation, and Ron's being prepared for surgery. Given the risks, we are the last thing they want in the operating theatre, so I'm downstairs watching the medical team's pictures in the hospital studio. I'll be able to talk to Dr. Shahinian throughout.

Dr. Shahinian: Let's get this show on the road.

Katie: Ron's skin and muscle is thicker than average and it takes almost 20 minutes to reach the skull. Dr. Shahinian marks a small circle on it to start drilling.

Dr. Shahinian: Okay, drill.

Katie: A hole the size of a five-pence is cut into Ron's skull. The brain membrane is opened up and the endoscope is ready to enter the head.

Dr. Shahinian: Okay, here we go team. And we're in. Okay, there's the cerebellum to my right. There's the inside of the skull ...

Katie: My goodness me. We can see that so clearly. For Dr. Shahinian, the rest of the operation takes place on a monitor, using the endoscope pictures to navigate deeper into Ron's head. Critical tissues are never far away.

Dr. Shahinian: This white structure that is at the tip of my instrument, right here ...

Katie: Yes.

Dr. Shahinian: That's the facial nerve. We injure that nerve, the patient's face will be paralyzed forever. This is the cerebellum I'm pushing a little bit. The white structure in the background ... that's the trigeminal nerve, right there.

Katie: And that's what's causing Ron's pain. It's still about five centimeters away, so an electrically heated clamp seals off minor blood vessels to open up the cavity.

Dr. Shahinian: On ... stop ...on ... stop. What's the nerve doing? Somebody watching the nerve?

Katie: And they're safely through. The white trigeminal nerve is on the left and the blood vessel that's irritating it is on the right.

Dr. Shahinian: This is the problem vessel right there. See it. I'm pushing it away. We're gonna take...lift this up, push it away from the nerve and put the Teflon between this and this.

Katie: Nonstick pads will permanently keep the vessel away from the nerve. But first, Dr. Shahinian has to tease them apart. Remember, this view is just six millimeters across, and Dr. Shahinian is now operating less than a millimeter from tissues which could result in a stroke or paralysis. With the membrane removed, Dr. Shahinian now uses a wider lens on the endoscope for a much clearer view.

Dr. Shahinian: Now, we're gonna put a 30-degree endoscope to look around this nerve, but you can see, it's really clean.

Katie: And to keep them separated, the Teflon pad.

Dr. Shahinian: That's about...a... four millimeters long and two millimeters wide, or something like that. I know it looks huge, but it's tiny.

Katie: And finally, a tiny drop of glue is squeezed in to hold the pads in place around the nerve, until the tissues grow back.

Dr. Shahinian: And we are coming out.

Katie: Two hours after they first opened up Ron, and the brain surgery's complete. Dr. Shahinian, how do you feel that went?

Dr. Shahinian: I feel that that went...a... as expected. Of course, we will have to wait until Mr. Adams wakes up and communicates to us to make sure that everything's okay.

Katie: Just three days later, Ron is back at home with Rita and already up and about. The medication for his jaw pain has been dramatically reduced. But, as expected, he still had some discomfort from the operation.

Ron: I've got some pain. Ah...I've got some headaches still. Ah...this incision hurts quite a bit, where it's stapled together. He said that was to be expected. And I have a little jaw pain yet, but he said that was also to be expected. But I'm off almost all the jaw medication.

Rita: Right now, he's barely three days since major brain surgery, and that's what it is. And I think he's doing marvelous. I'm just hoping that...that...ev...our...be... life gets back to normal. That he can be his old self again. We'll see if he can give me a kiss.

Rita and Ron Kiss

Ron: See, it didn't even hurt.

Peter: Marvelous story. Ron's operation's been a complete success. His pain has virtually disappeared, and he's off all his medication. He's got much more energy, and is able to do heavy work on the ranch for the first time in years.