Early evolution of neurological surgery: conquering increased intracranial pressure, infection, and blood loss

Abstract

At the end of the 19th century, the early evolution of the specialty of neurological surgery was restricted by complications related to infection, increased intracranial pressure, and excessive intraoperative blood loss. These complications often caused mortality rates of 30 to 50%. An improved understanding of pathophysiological factors involved in increased intracranial pressure, along with meticulous surgical techniques learned from William Halsted, allowed Harvey Cushing to increase the safety of neurosurgical procedures that were then in their infancy. Cushing's later development of the "silver clip" and incorporation of electrosurgical techniques facilitated safe resection of brain tumors previously assumed to be inoperable. These pivotal accomplishments paved the way for the establishment of our specialty.