History of neurosurgery
Neurosurgery represents a distinct discipline within medicine dealing with the surgical treatment of diseases of the central and peripheral nervous system. Particularly, these are injuries, tumors and malformations of the skull, brain, spinal cord and nerves, as well as functional disorders such as bleeding, vascular malformations, discogenic diseases but also functional disorders such as pain, epilepsy and movement disorders.
Although in ancient time neurosurgical procedures such as creating holes in skulls were carried out with great skill, no significant progress has been achieved until the end of the 19th century. On one hand, this was due to the lack of knowledge about role and function of the brain as well as the lack of means to examine the nervous system. After all, a development of surgical techniques was possible only after knowing about the importance of asepsis (sterility) and the development of methods for hemostasis and anesthesia.
The increasing understanding of the structure and function of the brain and the spinal cord, as well as the development of examination procedures have led to significant progress and beginning the life-sustaining phase of neurosurgery. It was now possible to control life-threatening conditions such as injuries, bleeding, or tumors and to save the lives of the affected patients. Due to the availability of modern imaging techniques in neuroradiology, such as computer tomography and magnetic resonance imaging, the introduction of the microscope for surgeries as well as the development of microsurgical techniques, the basis for function-preserving neurosurgery were established. Neurosurgery was not only about saving life but also about preserving important functions of the brain, spinal cord and nerves. Future developments will be in the field of functionally controlled neurosurgery and the use of biological treatments.
1. Older neurosurgery until the end of the 19th Century
Already in prehistoric times, trepanations (skull drillings) were performed. Historical findings prove that the interventions were executed with great skill and that the patients survived the procedure. Trepanations were performed for the treatment of traumatic brain injuries, especially depressed fractures, but also for the purpose of liberating from evil spirits, i.e. in the context of epileptic and mental illness. Since there was a great lack in knowledge of the anatomy and funtion, no specific interventions for certain diseases were possible. This changed with the development of neurology (studies of the diseases of the nervous system).
2. Conventional neurosurgery, late 19th Century to mid 1960ies
After knowing essential features of structure and function of the nervous system, processes could be localized on the basis of clinical symptoms and also in some cases surgeries could be performed. The first brain tumor was operated in 1884. The major problem was the localization of lesions within the brain or spinal cord for exact surgical planning. The pneumencephalography (filling of ventricles with air) and the ultrasound gave a rough estimate of the localization of tumors. Cerebral angiography (vascular imaging of the brain), which was established at the end of the 1920ies, was a milestone in imaging. Now it was possible for the first time to show vascular lesions directly. Examination of the vessels makes it possible to determine the localization of tumors. Using these methods it was also possible to get a first understanding about the character of a tumor (benign or malignant). At this time many surgical techniques and surgical approaches were developed by pioneers of neurosurgery, which are still in use. The road to modern neurosurgery, however, was only opened by the development of modern imaging techniques and microsurgical operative techniques.
3. Contemporary neurosurgery
Due to microsurgical techniques surgical operations have become possible even in difficult and functionally important brain areas. In particular, natural clefts and spaces in the brain could be used now to reach deep-seated lesions. Thus it became possible to reach almost every process without damaging the normal brain, cranial nerves or blood vessels. Today neurosurgery is marked by the important modern imaging techniques such as computed tomography and magnetic resonance imaging. These techniques enable the accurate imaging of pathological changes and their topographic relationsip to normal anatomical structures. Therefore precise pre-surgery planning has become possible. Microsurgical techniques and advanced imaging techniques reduced the mortality rate in neurosurgery significantly. The essential problem now was not only the preservation of life but also the preservation of function. Therefore, contemporary neurosurgery is often characterized as function-sustaining neurosurgery.
Author: Vera van Velthoven-Wurster
Prof. Dr. Juergen Beck
Secretary V. Leonhardt
Phone +49(0)761 270-50060