Exploring Advances Looming on
the Neurosurgical Horizon
This is an extraordinary time in neuroscience. Molecular, cellular and systems approaches are providing discoveries that were unimaginable only a few years ago. At the molecular level, we have seen the three-dimensional structure of an ion channel at atomic resolution. We have discovered an astounding diversity of neurotransmitters, neuromodulators, neurotrophic factors and their cognate receptors by molecular cloning. In addition, remarkable structural and functional similarities are emerging between genes and proteins in humans and those in flies, worms and yeast. Clues to many neurological disorders will be uncovered by studying these simpler organisms.
At the cellular level, we are unraveling the complex regulatory pathways and discovering common mechanisms, such as “cell suicide” programs, that contribute to many disorders, both acute and chronic. We have much clearer ideas about how neurons integrate diverse influences and express their conclusions in activity via the modulation of individual ion channels.
At the systems level, multi-electrode recordings and non-invasive imaging have shown relations between systems not previously suspected, and are bringing questions related to attention, awareness, planning, movement, mood, and even consciousness into sharper focus.
One might think that with each new discovery, scientists working at different levels of analysis would have less to say to one another, as technical jargon becomes less penetrable. Remarkably, quite the opposite appears to be happening – new discoveries have begun to unify neuroscience rather than drive it apart. As our understanding converges in new opportunities for treating human disorders, neurosurgeons must take an active leadership role.
What Does This Mean for Neurosurgery
Certainly, exacting and innovative neurosurgical approaches are essential to new therapies. More precise localization of lesions has revolutionized the treatment of Parkinson’s disease and epilepsy, among other disorders. Deep brain stimulation is one of the most promising therapies for movement disorders to emerge in years. Cell therapies, whether with adult progenitors, embryonic cells or engineered cells, hold enormous promise. So, too, does gene therapy, if we can overcome the problems of control and delivery. Implantable devices may soon predict the onset of seizures and deliver precisely timed and localized drugs to prevent them. Targeted therapeutics may seek out and destroy tumor cells. Neural prostheses that rely on direct cortical control are no longer science fiction. The horizon is unlimited.
Considering this limitless horizon, how should the next generation of academic neurosurgeons be trained? Surely they must be experts at their trade. They also must understand the neuroscience that will provide therapeutics of the future. At the very least, they must be informed collaborators.
In some cases, practicing neurosurgeons will be leaders in the laboratory as well. Although it is easier to clone a gene, modify a protein, record from small single neurons, and observe the function of large ensembles of neurons than ever before, time must be allowed in training programs to become familiar with these approaches. The National Institute of Neurological Disorders and Stroke (NINDS) is committed to helping, by planning and creating novel funding mechanisms.
As the NINDS emerges from the Decade of the Brain and marches into the 21st century, we plan to celebrate the accomplishments of brain research over the past 50 years, and to peer into the future. We invite AANS members to offer suggestions for specific events to kick-off a neuroscience festival beginning in April of 2001.
New Neuroscience Research Center
One effort that we hope will crown the celebration is the creation of a National Neuroscience Research Center at the National Institutes of Health (NIH). This effort, culminated by new research facilities,,, will bring molecular and behavioral scientists together to emphasize the major themes of brain research, including neurodegeneration, neural repair and plasticity, synapses and circuits, cognition and behavior, neurogenetics, and the neural environment. The emphasis will be on translational research and the hope is to speed the translation of basic discoveries to useful therapeutics.
Our plan is for the Center to become a resource for the entire country, by sharing resources (animals, imaging, behavioral, etc.) and offering unique training opportunities. We hope to seed the community in much the same way that the NIH did in the 1960s and 1970s. We need your support in this effort. Public support has never been higher and we have witnessed a remarkable increase in the NIH budget over the past two years. At this pace, the budget will double (compared to the 1998 level) in the next three to four years. The increase in the budget cannot be spent on more of the same. We have an obligation to plan in the coming years. To do this effectively, we need input from the neurosurgical community.