History of neurosurgical techniques in head injury

For many centuries, surgical procedures had to be fast and sharp. Suppuration of the surgical wounds was not the exception but the rule. The Hippocratic tradition of wet wound management and the concept of laudable pus was seriously challenged in the fourteenth century. When cauterization was opposed by Paré in the sixteenth century, the patients suffered less and the wounds healed better. Surgeons learned about the significance of brain compression during the second half of the eighteenth century. With the introduction of asepsis, antiseptics, cerebral localization, and anesthesia during the second half of the nineteenth century, trephination became more attractive and less fatal. For the first time, surgeons broached the dura with impunity, feeling confident that they could take care of a compressive pathology with a good chance that the patient could survive intracranial sepsis. Imaging studies, antibiotics, electrocautery, and mechanical suction during World War II made surgical procedures safe, anatomically sound, and results predictable. Sectional imaging of the 1970s and 1980s made it possible to evaluate the intracranial pathologies and correlate them with pathophysiology of traumatic brain injury, hence, surgeons were able to predict outcomes more efficiently.