Neurosurgery in the Past and Future. An Appraisal

the early 1970s helped to delineate brain lesions in a better manner; marginally raising the comfort level of the neurosurgeon. The invention of cerebrospinal fluid diversion procedures for hydrocephalus was a significant advance in the management of raised intracranial pressure. The introduction of magnetic resonance imaging (MRI) in the 1990s and invention of the high magnification surgical microscope provided a giant leap forward in the surgical resection of brain tumours. This was coupled with progress in neuroanaesthesia techniques and management of intracranial pressure which helped the neurosurgeon to operate on a relaxed brain; thereby promoting a safe maximal resection of the brain tumour, as well management of vascular lesions. The enhanced magnification provided by the surgical microscope improved the understanding of micro-surgical anatomy and the confidence of the micro-neurosurgeon. In the 1950s and 1960s, the discovery of radiation treatment and chemotherapy as an adjuvant therapy for malignant brain tumours, which could not be removed completely, provided a further boost to reduce mortality and morbidity. Broad spectrum antibiotics and steroids in the treatment of central nervous system infections have made a significant impact on reducing the fulminant nature of central nervous system infections and the incidence of brain abscesses. In the last 20 years of the 20th century, endovascular procedures have been a good adjunct for treatment of arteriovenous malformations, and a primary modality for treatment of aneurysms, thus avoiding a craniotomy.