Neurosurgery as a specialty is about 150 years old. Prior to that General Surgeons with some interest used to operate on the brain. The invention of X rays by Roentgen was a landmark in 1890’s and X rays of the skull were done to find out some calcifications inside the skull.
Around the same time one American Surgeon called Harvey Cushing took special interest in Neurosurgery and started operating on the brains. He visited many centers in Europe and got fascinated by Syphgmomanometer, an instrument developed by Riva Rocci in Italy, to measure blood pressure. He started using it during surgeries to monitor the blood pressure and this paved the way for intra operative monitoring.
Neurosurgical procedures used to be very messy with bleeding from the bone and also from the brain. One British Surgeon called Victor Horsley invented a substance called Bone wax, a combination of Bees wax and Phenol, that could be used to control the bleeding from the bone. Incidentally he was the first person to remove a spinal cord tumor with very good results. Bone wax is used even now in all surgical procedures were the bone is cut.
The introduction of monopolar by Harvey Cushing and subsequently bipolar cautery by Leonard Mallis, made control of bleeding from brain very easy. Simultaneously neurology also made rapid progress and neuro physicians started making precise clinical diagnosis. One of the students of Harvey Cushing, Walter Dandy introduced a procedure called Pneumoencephalography, where air was introduced into the cranial cavity and X rays were taken. The air could give a double contrast and it aided in diagnosing neurosurgical conditions. But the outcome was very bad with severe wound infections and brain swelling which resulted in very high mortality. Around 1930’s one French Surgeon, Sicard introduced a procedure called Myelography. Here a contrast medium was introduced into the spinal cavity and X rays were taken. The contrast used to indirectly show tumors and aid in diagnosis.
Around the same time one Spanish Surgeon by name Egaz Moniz developed a procedure called Angiography. Here a contrast medium was injected into the blood vessels and X rays were taken. Tumours and blood clots in the brain could be detected by this procedure indirectly by seeing the shift of blood vessels in the X rays. The contrast medium used to highlight the blood vessels. This was the main modality of investigation for the next 40 odd years. The procedure itself had many side effects and many a time patients used to have huge blood clots at the puncture site in the neck.
The contrast medium used was also toxic and many drug reactions used to occur.1940s’ saw the advent of Sulphonamides and Pencillin and they had a very large role to play in the control of wound infection. The infection rate in all surgeries fell down dramatically and operative results became better, but still neurosurgeons had to battle another condition called brain swelling or brain edema. The nervous tissue used to swell up when handled and this used to produce a lot of morbidity. Steroids were invented in 1950’s and this came as a panacea for all neurosurgeons. Steroids controlled brain edema well and the surgical o utcome became much better.
