The future of cerebral surgery: a kaleidoscope of opportunities

The emerging future of cerebral surgery will witness the refined evolution of current techniques, as well as the introduction of numerous novel concepts. Clinical practice and basic science research will benefit greatly from their application. The sum of these efforts will result in continued minimalism and improved accuracy and efficiency of neurosurgical diagnostic and therapeutic methodologies.Initially, the refinement of current technologies will further enhance various aspects of cerebral surgery. Advances in computing power and information technology will speed data acquisition, storage, and transfer. Miniaturization of current devices will impact diverse areas, such as modulation of endoscopy and endovascular techniques. The increased penetrance of surgical technologies such as stereotactic radiosurgery, neuronavigation, intraoperative imaging, and implantable electrodes for neurodegenerative disorders and epilepsy will enhance the knowledge and experience in these areas and facilitate refinements and advances in these technologies. Further into the future, technologies that are currently relatively remote to surgical events will fundamentally alter the complexity and scale at which a neurological disease may be treated or investigated. Seemingly futuristic concepts will become ubiquitous in the daily experience of the neurosurgeon. These include diverse fields such as nanotechnology, virtual reality, and robotics. Ultimately, combining advances in multiple fields will yield progress in diverse realms such as brain tumor therapy, neuromodulation for psychiatric diseases, and neuroprosthetics. Operating room equipment and design will benefit from each of the aforementioned advances. In this work, we discuss new developments in three parts. In Part I, concepts in minimalism important for future cerebral surgery are discussed. These include concrete and abstract ideas in miniaturization, as well as recent and future work in microelectromechanical systems and nanotechnology. Part II presents advances in computational sciences and technological fields dependent on these developments. Future breakthroughs in the components of the "computer," including data storage, electrical circuitry, and computing hardware and techniques, are discussed. Additionally, important concepts in the refinement of virtual environments and the brain-machine interface are presented, as their incorporation into cerebral surgery is closely linked to advances in computing and electronics. Finally, Part III offers insights into the future evolution of surgical and nonsurgical diagnostic and therapeutic modalities that are important for the future cerebral surgeon. A number of topics relevant to cerebral surgery are discussed, including the operative environment, imaging technologies, endoscopy, robotics, neuromodulation, stem cell therapy, radiosurgery, and technical methods of restoration of neural function. Cerebral surgery in the near and distant future will reflect the application of these emerging technologies. As this article indicates, the key to maximizing the impact of these advancements in the clinical arena is continued collaboration between scientists and neurosurgeons, as well as the emergence of a neurosurgeon whose scientific grounding and technical focus are far removed from those of his predecessors.