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The Genesis of Neurosurgery and the Evolution of the Neurosurgical Operative Environment: Part IIConcepts for Future Development, 2003 and Beyond

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

Special Articles

THE FUTURE DEVELOPMENT of the neurosurgical operative environment is driven principally by concurrent development in science and technology. In the new millennium, these developments are taking on a Jules Verne quality, with the ability to construct and manipulate the human organism and its surroundings at the level of atoms and molecules seemingly at hand. Thus, an examination of currents in technology advancement from the neurosurgical perspective can provide insight into the evolution of the neurosurgical operative environment. In the future, the optimal design solution for the operative environment requirements of specialized neurosurgery may take the form of composites of venues that are currently mutually distinct. Advances in microfabrication technology and laser optical manipulators are expanding the scope and role of robotics, with novel opportunities for bionic integration. Assimilation of biosensor technology into the operative environment promises to provide neurosurgeons of the future with a vastly expanded set of physiological data, which will require concurrent simplification and optimization of analysis and presentation schemes to facilitate practical usefulness. Nanotechnology derivatives are shattering the maximum limits of resolution and magnification allowed by conventional microscopes. Furthermore, quantum computing and molecular electronics promise to greatly enhance computational power, allowing the emerging reality of simulation and virtual neurosurgery for rehearsal and training purposes. Progressive minimalism is evident throughout, leading ultimately to a paradigm shift as the nanoscale is approached. At the interface between the old and new technological paradigms, issues related to integration may dictate the ultimate emergence of the products of the new paradigm. Once initiated, however, history suggests that the process of change will proceed rapidly and dramatically, with the ultimate neurosurgical operative environment of the future being far more complex in functional capacity but strikingly simple in apparent form.

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, and Institute for Creative Technologies, Marina Del Rey, 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