%0 Journal Article
%T From the Idea to Its Realization: The Evolution of Minimally Invasive Techniques in Neurosurgery
%A P. Grunert
%J Minimally Invasive Surgery
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/171369
%X Minimally invasive techniques in neurosurgery evolved in two steps. Many minimally invasive concepts like neuronavigation, endoscopy, or frame based stereotaxy were developed by the pioneers of neurosurgery, but it took decades till further technical developments made the realization and broad clinical application of these early ideas safe and possible. This thesis will be demonstrated by giving examples of the evolution of four minimally invasive techiques: neuronavigation, transsphenoidal pituitary surgery, neuroendoscopy and stereotaxy. The reasons for their early failure and also the crucial steps for the rediscovery of these minimally invasive techniques will be analysed. In the 80th of the 20th century endoscopy became increasingly applied in different surgical fields. The abdominal surgeons coined as first for their endoscopic procedures the term minimally invasive surgery in contrast to open surgery. In neurrosurgery the term minimally invasive surgery stood not in opposiotion to open procedures but was understood as a general concept and philosophy using the modern technology such as neuronavigation, endoscopy and planing computer workstations with the aim to make the procedures less traumatic. 1. Introduction Despite success in surgical technique permitting to perform hemicraniotomy for removing a small intracranial lesion, one cannot but admits, both a priori and from clinical experience, the necessity to minimize surgical injury and approve all methods of precise localization of a cerebral lesion. GI Rossolimo, J Neuropath Psych Korsakow 1907; 7: p 640. This statement of Rossolimo, one of the leading Russian neurologists at the beginning of the 20th century, shows that the idea of minimally invasive neurosurgery was already appreciated by the pioneers of this discipline. Atraumatic operative techniques were considered from the beginning in neurosurgery due to the disastrous possible functional complications inherent to manipulations on the central nervous system. However due to technical limitations most of the promising projects and concepts had to be postponed at the end of the 19th and beginning of 20th century and had to wait sometimes even many decades till technical developments, necessary diagnostic radiological imaging, and the appropriate operative instruments made a safe clinical application of these nearly forgotten ideas in the second half of the 20th century possible. An example for an extreme long time-lag between an idea and its technical realization may serve the development of automata and robots. The main concept of these
%U http://www.hindawi.com/journals/mis/2013/171369/