Protecting the brain from neurosurgeons: recent advances in neural protection in neurosurgery

Neurons are at risk of mechanical and ischaemic damage during neurosurgery. Recent advances in imaging, monitoring, anaesthetic, and surgical techniques play an important role in neural protection during neurosurgery. Significant advances were made in neurosurgery as a result of the structural imaging provided by CT and MRI. Further improvements in surgical decision making and planning are now being made with functional and physiological imaging such as functional MRI (fMRI), PET, SPECT, and combinations of these modalities. Intra-operative electrophysiological monitoring can be used as a localiser of function as well as provide the surgeon with warning of impending damage. Surgical and anaesthetic techniques have evolved to minimise physical and ischaemic brain trauma. Neurosurgery has evolved dramatically over the last two decades. The current focus is on surgical planning and decision-making, minimally invasive techniques, and protection of neurological function.