Neurosurgery o/the Future: Computers and Robots in Clinical
Neurosurgical Practice and in Training - a Philosophical Journey into
the Future Many present day neurosurgeons believe that they already
obtain good results in operative surgery with the benefit of the
operating microscope and other aids which have become available in the
last three decades and that the introduction of computers and robots to
the operating theatre is superfluous. However, it is clear from analogy
with the function of the airline pilot, another profession where there
are great demands on manual skill and on spatial awareness, that these
devices do have much to offer neurosurgery. Classical neurosurgery, in
the time of Cushing, Dandy and Scarff, was based on a three dimensional
picture of the patient's brain formed in the surgeon's mind and often
illustrated in elegant drawings. Such pictures were based on
neuroradiological studies by pneumoencephalography, ventriculography or
by angiography. Generally these stud- ies showed the presence and
position of a lesion by displacement of normal brain structures and the
picture was built up by interference. This was then converted by the
experienced neurosurgeon into a plan for the craniotomy site and the
trajectory of the surgical approach. Once the brain was exposed further
pre-operative information was obtained by visual inspection and by
palpation with the brain needle. These classical forms ofneuroradiology
have largely been superseded by computerised tomography and by magnetic
resonance imaging.