TABLE OF CONTENTS Whilst the second half of the 20th century has seen the most far-reaching advances in surgical techniques, and some of these will be discussed later, it may come as quite a surprise to discover how long ago surgeons were practising, and perfecting, some extremely sophisticated procedures. So as to preserve some kind of order, I shall start with the head, and then progress downwards to the chest and abdomen, and thence to the arms and lower limbs. I shall also concentrate on the procedures which have evolved by what may be described as "open" surgery, before turning to the more recent and sophisticated techniques of micro, and minimal access surgery.
In most cases neurosurgery involves cutting through the skull, either to relieve pressure or to perform an operation on a specific site. While surgeons have been drilling through the skull for hundreds of years (see Chapter 9), and had with some success treated abscesses and tumours on the outer surface of the brain, entry into the brain itself required a great deal of knowledge and dexterity, much of which was achieved by trial and error.
A distinguished pioneer in this field was the American surgeon Harvey Cushing (1869-1939). He was professor of surgery at Harvard University from 1912 and, owing to his ability and attention to detail, the death rate during brain surgery dropped from over 30% to as little as 5%.
Neurosurgery has developed into a highly sophisticated branch of the art; and in...
