• The history of Neuro Surgery

Throughout the course of history, the evolution of neurosurgery perpetually involved the narrative surrounding different eras, punctuated by relevant discoveries in the field of medical science. Primitive mystical and therapeutic reports file the first descriptions of primeval cranial surgical procedures, including cranial perforation, called trepanation, a technique designated for individuals with mental disorders, headaches and head injuries.

• Pioneering Neuro - Surgeons

Harvey Cushing, a physician and neurosurgeon at Harvard University, marked the 20th century with his involvements that influenced the history of medicine and made him one of the greatest references of all time. Among his achievements are the use of radiography in the diagnosis of brain tumors, the encouragement of studies and research on electroencephalic stimulation, and the demonstration of the importance of knowledge and control of intracranial pressure, contributing to the historical decrease in mortality from brain tumors, becoming, therefore, the precursor of a new era, the Cushing Era. Still in the 20th century, there was the advent of new imaging techniques, such as radiology and radiotherapy, permitting for better surgical consequences and allowing the association of neurosurgery as a well-defined specialty worldwide. In parallel to this, the development of new microsurgical techniques by M. Gazi Ysargil, a Turkish neurosurgeon, ushered in a new era in neuro-medicine. New surgical instruments were invented, which transformed the scenario of surgical microanatomy and resolved technical limitations that, until then, made some patients inoperable. In 1980, there was a great advance in the history of medical science with the first use of robotics to perform neurosurgical biopsies, a fact of extreme importance that increased the search for robotic systems that contributed to microsurgery.

• A rapidly evolving speciality

Neuro surgery is a rapidly developing speciality and has often taken a lead in adopting new technologies. Advancing technology though is not the only force driving change in this stream. Other factors include an escalation in patient expectations, an increasing and ageing population couples with the prevailing economic conditions.

• Trends in Neuro Surgery

Neurosurgical practice has clearly advanced over the last decade. Predictable changes include a trend towards coiling rather than clipping of cerebral aneurysms, an increasing number of tumour resections

(particularly for malignant glioma) along with the increased use of image guidance and endoscopy.

The number of operations on the cervical spine has also increased although overall the number of procedures for spinal degenerative conditions has declined, perhaps reflecting local practice. The rates of craniotomy for trauma and burr holes for chronic subdural haematoma have remained essentially unchanged.

The most important changes have occurred in the fields of neuro-oncology, vascular neurosurgery and spinal surgery. Inter-specialty collaboration is establishing itself as a model of care.

• Neuro Surgical advances in the 21st century

The 21st century brings with it multiple challenges and opportunities in view of the explosion in information technology, as well as major advances in molecular biology and genetics. Computers in medicine have revolutionised the investigative modalities, as well as diagnosis and treatment paradigms. Neuro-imaging, intra-operative neuro-monitoring, neuro-navigation, and neuro-modulation are computer-based applications which are now routinely used in standard neurosurgical practice.