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Surgical Neurology 69 (2008) 102www.surgicalneurology-online.com

Editorial

The challenge for neurosurgery in the 21st century

The world is undergoing a rapid cultural, social,economic, informational, technological, and scientific revo-lution never experienced before in human history. At any onetime, we can see and talk with people all over the worldinstantly, buy goods in any part of the world on the Internet,experience different cultures immediately, and be exposed toamazing advances in science and technology that will changeour lives daily. How will these changes affect neurosurgeryin the 21st century?

The advances in scientific knowledge are so rapid that in 5to 10 years, most of what one has learned is out of date. Thisfundamental truth alone will force physicians to practice ingroups as specialists: neurosurgical groups and ultimately,neuroscience groups of neurologists, neurosurgeons, neuro-radiologists, physiatrists, and basic scientists. Groups ofmedical specialists will become the most efficient and best atdelivering care as medicine becomes more complex. Therevolution in genetics and molecular biology will transformthe practice of medicine into molecular medicine andmolecular imaging. From the genetic makeup of patients,we will know their risks of complications and be able toprevent them with surgery and medicine. Surgery willbecome minimally invasive and will eventually disappearas the targeted genetic and molecular treatments willeliminate the major diseases we face worldwide. Roboticsurgery will be practiced. Nanotechnology will enhance themolecular revolution and combine with targeted therapies.There will be medicolegal challenges associated with thesefuture changes.

Neurosurgery will become a part of a broad specialty ofneuroscience as neurologists, neurosurgeons, psychiatrists,physiatrists, neuroradiologists, and basic scientists practicetogether on a common brain. Functional and biochemicalimaging studies will reveal the biochemical basis of alldiseases from psychiatric or functional disorders, toneoplasms, to degenerative processes. Rehabilitation of thenervous system will become a dynamic specialty as nerve

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regeneration, and the prevention of further cell damage willpredominate in therapy.

In the acute stage of disease, the management will becomebiochemically, genetically, and molecularly based, so thatbrain cell recovery will become the primary goal asneurointensive care becomes a leading specialty. Recoveryof the nervous system after injury and surgery will become thekey to better outcomes as opposed to the care we now give.

Life expectancy will pass 100 and go to 150, somepredicting 400 years. The challenge of what to do with ahealthy body and mind will overwhelm society that nowcannot take care of its elderly.

Large databases of each patient's history and medicalcourse will be recorded worldwide and used to predict thebest treatments, and their images will be used as a basis forcomparison of images and medical diagnoses. This techno-logical and information revolution will totally change theposition of the physician in health care as artificial intelligentmachines will perform functions better than any human.

Neurosurgery as we know it today will be of historicalinterest.

Neurosurgeons should become familiar with the newadvances in science and technology and begin to work inteams with other specialists on diseases. It is already beingdone in epilepsy and movement disorders.

Technology will bring medical care to all people andeliminate the shortage of physicians. Patients will travel allover the world for excellent care or consult electronicallywith specialists worldwide. Physicians are slow to under-stand this revolution and reluctant to change. Those thatchange will win in the market place of the future, whereasthose who do not will fail.

James I. Ausman, MD, PhD(Editor)

E-mail address: surgicalneurology@dc.rr.com