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The Genesis of Neurosurgery and the Evolution of the Neurosurgical Operative Environment: Part IPrehistory to 2003

Liu, Charles Y. M.D., Ph.D.; Apuzzo, Michael L.J. M.D.

Special Articles

DESPITE ITS SINGULAR importance, little attention has been given to the neurosurgical operative environment in the scientific and medical literature. This article focuses attention on the development of neurosurgery and the parallel emergence of its operative setting. The operative environment has, to a large extent, defined the “state of the art and science” of neurosurgery, which is now undergoing rapid reinvention. During the course of its initial invention, major milestones in the development of neurosurgery have included the definition of anatomy, consolidation of a scientific basis, and incorporation of the practicalities of anesthesia and antisepsis and later operative technical adjuvants for further refinement of action and minimalism. The progress, previously long and laborious in emergence, is currently undergoing rapid evolution. Throughout its evolution, the discipline has assimilated the most effective tools of modernity into the operative environment, leading eventually to the entity known as the operating room.

In the decades leading to the present, progressive minimalization of manipulation and the emergence of more refined operative definition with increasing precision are evident, with concurrent miniaturization of attendant computerized support systems, sensors, robotic interfaces, and imaging devices. These developments over time have led to the invention of neurosurgery and the establishment of the current state-of-the-art neurosurgical operating room as we understand it, and indeed, to a broader definition of the entity itself. To remain current, each neurosurgeon should periodically reconsider his or her personal operative environment and its functional design with reference to modernity of practice as currently defined.

Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, and Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, California

Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California

Reprint requests:

Michael L.J. Apuzzo, M.D., 1200 N. State Street, Suite 5046, Los Angeles, CA 90033.

Received, May 31, 2002.

Accepted, September 11, 2002.

Copyright © by the Congress of Neurological Surgeons