Intended for healthcare professionals

Clinical Review Recent advances


BMJ 1999; 318 doi: (Published 02 January 1999) Cite this as: BMJ 1999;318:35

This article has a correction. Please see:

  1. Michael Powell, consultant.
  1. National Hospital for Neurology and Neurosurgery, University College London Hospitals, London WC1N 3BG
  • Accepted 13 May 1998

Neurosurgery changes constantly. Recent years have seen important organisational changes in the way units are run, such as the proliferation of subspecialisation among consultants and the use of a multidisciplinary team approach to problems. Inevitably, however, it is new equipment that catches the eye of the public, and in recent years exciting new technology has expanded and refined the discipline of neurosurgery.


This article is a combination of my views on important recent advances and those of colleagues. Our unit is visited regularly by neurosurgeons and neuroscientists from all over the world. The advances I discuss are common knowledge among British neurosurgeons —a small community which debates developments twice a year at the Society of British Neurological Surgeons meetings. Some of the developments described have just become available commercially and some are still unproved.

New technology

While subspecialisation and teamwork have made a substantial difference to the running of neurosurgical units, new technology, on which neurosurgery has always depended, has expanded the repertoire of the neurosurgeon. Some technological developments are completely new, whereas others are based on refinements of existing equipment. Although there has been nothing quite like the revolution brought about by the introduction of computed tomography, frameless stereotaxy and, possibly, interventional magnetic resonance imaging have the potential to change the face of neurosurgery.1

Frameless stereotaxy

The most important change in the past few years has undoubtedly been the introduction of frameless stereotaxy. The equipment helps the surgeon navigate safely through high risk areas of the skull and brain by allowing him or her to know exactly where he or she is at the time. This has given the neurosurgeon confidence in undertaking difficult tasks such as complex surgical approaches through the base of the skull and the resection of tiny lesions in the middle of the brain. Since the advent of …

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