The concept of minimally invasive neurosurgery

Applying the concept of keyhole techniques to neurosurgery has divided the neurosurgical community. This should never have happened because keyhole refers to a philosophy not a size. This philosophy stems from a desire to minimize collateral damage without compromising the intended goal of surgery. The revolution received its impetus from technological advances in pre- and intraoperative navigation, use of surgical-friendly anesthetic agents, lower profile instruments, the introduction of hemostatic agents, and better visualization. If a smaller craniotomy compromises the goal of surgery, then the approach should be re-evaluated and modified to achieve minimal collateral damage and maximal efficacy.