The evolution of neurosurgery: how has our practice changed?

Neurosurgery is a rapdily evolving speciality and has often taken a lead in adopting new technologies. Advancing technology however is not the only force driving change in this discipline. Other factors include an escalation in patient expectations, an increasing (and ageing) population and the prevailing economic conditions. The aim of our study was to analyse the trends in neurosurgical practice over a 10-year period.

The details of every neurosurgical procedure performed at Wellington Regional Hospital from 2001 to 2011 were prospectively recorded in a relational database. This was then retrospectively interrogated to provide data for this study.

Neurosurgical practice has clearly evolved over the last decade. Predictable changes include a trend towards coiling rather than clipping of cerebral aneurysms, an increasing number of tumour resections (particularly for malignant glioma) coupled with the increased use of image guidance and endoscopy. The number of operations on the cervical spine has also increased although overall the number of procedures for spinal degenerative conditions has declined, perhaps reflecting local practice. The rates of craniotomy for trauma and burr holes for chronic subdural haematoma have remained essentially unchanged. We have demonstrated a significant increase in annual case-load that is disproportionate to any change in population size. Collaboration between specialties is increasingly evident.

The most important changes have occured in the fields of neuro-oncology, vascular neurosurgery and spinal surgery. Inter-specialty collaboration is establishing itself as a model of care. These data may guide resource allocation for a population increasing both in number and in age.