Trends in neurosurgery

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NEUROSURGERY is a branch of the surgical art concerned with the treatment of lesions of the nervous system. American neurosurgery was fathered by Harvey Cushing, whose self-selected greatest achievement in a long and brilliant career as a neurosurgeon was that of learning to “stitch the galea.” When that surgical step involving secure scalp closure became routine, the patient’s nervous system could be entered safely for whatever surgical treatment was required. Cushing had at his command anesthesia, asepsis, simple roentgenography, and cerebral localization. His skillful employment of these adjuncts for the benefit of patients provided the impetus for the development of a surgical specialty—neurosurgery.

By 1919, Walter Dandy, another great neurosurgeon, had developed pneumoencephalography and ventriculography, technics that enormously facilitated the diagnosing of intracranial lesions, which until then had been diagnosed almost entirely by means of neurology. By 1935, Antonio Egas Moniz of Portugal had developed cerebral angiography to illuminate further the living cerebral anatomy, and particularly to encourage treating cerebrovascular lesions. In 1948, George Moore reported the discovery of a means of demonstrating transgressions of the diseased blood-brain barrier, which led to the development of isotopic encephalography. While these diagnostic adjuncts were being developed, neurophysiologists were using electrodes and progressively more sophisticated electronic recorders to trace with ever finer accuracy the neurologic pathways known earlier only in the gross form. Elaboration of some of the instruments gave rise to stereotactic surgery of the nervous system, to treat neurologic conditions previously out of reach of neurosurgeons.

In 1934, 33 years. . .



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