The thorny road to minimally invasive techniques in neurosurgery

This article is a brief personal account of a neurosurgeon who started his career in 1950. In spite of the subjective nature, this paper also attempts to provide some objective evidence to the history of our specialty. The terrible pain-causing pneumoencephalography and percutaneous carotid angiography, indispensable of the neurosurgery yesterday, seem to be a nightmare even for a physician today. The psychological stress of a patient at a brain operation in local anaesthesia was enormous, not to speak about the vegetative instability inherent with this anaesthesiological modality. The technical and scientific progress in the last decades, the modern diagnostic methods, the introduction of microsurgical technique and the modern anaesthetical methods and intensive care brought about an important change in the strategy and tactical considerations of neurosurgical interventions. Today the aim of our operations is not only to save life, but to improve the quality of life of the patient. Our surgical policy is directed by the knowledge of microscopical anatomy, the knowledge of arachnoidal membranes and cisterns and the introduction of microneurosurgical techniques.