Neurosurgery is the medical specialty focused on the surgical treatment and rehabilitation of disorders affecting the nervous system, including the brain, spinal cord, and peripheral nerves. The question of when the first “brain surgery” occurred is complicated, depending on whether one seeks the earliest physical intervention on the skull or the first successful procedure aimed at curing internal neurological disease. The history of operating on the human head spans millennia, requiring a distinction between rudimentary, ancient practices and the scientific discipline that emerged much later.
The Earliest Procedures: Evidence of Trepanation
The oldest known surgical procedure involves the skull, a practice called trepanation, which is the act of drilling, scraping, or cutting a hole into the cranium. Archaeological evidence shows this procedure was performed as early as the Neolithic period, with the earliest trepanned skulls dating back approximately 7,000 years to sites in France. This practice was widespread across various ancient cultures, from Europe and Africa to the Incan civilization in Peru.
The reasons for trepanation were diverse, ranging from the practical to the spiritual. It was often performed to treat head injuries, such as depressed skull fractures, where relieving pressure could save a life. Evidence of trepanned skulls with signs of bone regrowth indicates that many patients lived for significant time after the operation. Beyond trauma, it was also used to treat chronic ailments like headaches, seizures, and mental illness, which were sometimes attributed to evil spirits that needed to be released from the skull.
The Anatomical Revolution and Surgical Stagnation
The period from the Renaissance onward brought profound advancements in understanding the human body, particularly the brain. Anatomists like Andreas Vesalius in the 16th century produced detailed and accurate illustrations of the nervous system, which corrected centuries of flawed understanding. This anatomical revolution clarified the brain’s complex structure, but it also revealed the extreme danger of internal brain surgery.
Despite knowing the anatomy, any attempt to operate deeper than the surface of the skull remained fatal for centuries. The primary obstacles were the lack of two essential technologies: anesthesia and antisepsis. Without effective anesthesia, a patient could not endure the prolonged surgery required to address complex internal pathology. Furthermore, a lack of antiseptic techniques meant that surgical wounds almost always resulted in lethal infection, making the brain a particularly vulnerable target.
Defining the First Modern Brain Surgery
The true birth of neurosurgery as a successful, curative medical discipline occurred in the late 19th century, following a confluence of three scientific breakthroughs. The development of general anesthesia allowed surgeons the necessary time to perform complex procedures. Simultaneously, the introduction of antiseptic and aseptic techniques, pioneered by figures like Joseph Lister, drastically reduced post-operative infection, transforming surgery from a high-risk gamble into a viable treatment.
The third breakthrough was the principle of cerebral localization, the understanding that specific functions like movement and language are mapped to distinct areas of the brain. This knowledge allowed surgeons to precisely locate internal lesions, such as tumors or abscesses, based solely on a patient’s neurological symptoms. In 1879, Scottish surgeon William Macewen performed one of the first successful removals of a brain tumor, locating it using only these neurological signs.
The English surgeon Sir Victor Horsley is often credited as the world’s first neurosurgeon, having been appointed to the first hospital post dedicated entirely to brain surgery in 1886. Horsley used antiseptic methods and successfully removed a spinal tumor in 1887, demonstrating the possibility of safe nervous system surgery. Later, American surgeon Harvey Cushing, often called the “father of modern neurosurgery,” synthesized these advancements and developed meticulous techniques to control bleeding and manage intracranial pressure. Cushing’s work in the early 20th century reduced the mortality rate for brain tumor surgery from nearly 90% to under 10%, establishing neurosurgery as a separate and viable specialty.