[Concepts of development of the neurosurgical operative environment in the 21st century]

The operative environment has to a large extent defines the "state of the art and science" of neurosurgery, which is now undergoing rapid reinvention. In order to remain current, each neurosurgeon should periodically reconsider their personal operative environment and its functional design with reference to modernity of practice as currently defined. Historical trends and their analysis offer predictive guides for development of such settings with an eye toward the future. Examination of technical developments in decade timeframes defines the progress in capability and need. Progressive minimalism of manipulation and the presence of operative definition with increasing precision are evident, with concurrent miniaturization of attendant computerized support systems, sensors, robotic interfaces, and imaging devices. These trends and developments offer the opportunity for simplificity of setting design with higher functionality as the desired endpoint.