When you walked into the exhibit hall at this year’s AANS meeting, were you appalled by the profusion of vendors, each hawking its device as the next indispensable tool in neurosurgery? Isn’t this just another sign of the ongoing commercialization of our noble profession?
No, it isn’t. Neurosurgery and industry have been excellent partners for a long time now. Consider that the neurosurgical operating microscope, first used by Theodore Kurze in 1957, grew out of a century’s worth of optical engineering by Carl Zeiss Inc. The collaboration between Zeiss and such neurosurgeons as R.M. Peardon Donaghy, M. Gazi Yasargil, and Leonard I. Malis is well-known.
We all use electrocautery for hemostasis and surgical exposure. The monopolar cautery, known as “the Bovie,” is still widely used. W.T. Bovie, a professor of biophysics at Harvard University in the 1920s, worked with Harvey Cushing to develop a new technique for “electrosurgery,” which Cushing reported in 1927. By 1931 Ernest Sachs wrote that “the Bovie…is replacing silver clips to a large extent but it never can entirely supplant the muscle graft.” (Never say never.)
Most neurosurgeons today have used a pneumatic or electric power tool to open the skull or drill the spine. These devices were developed first in the late 19th century by a large number of competing manufacturers, most of which began as makers of dental instruments. There were promoters (de Martel, Olivecrona) and detractors (Horsley, Cushing) of power-driven neurosurgery.
We can go further back in time. In 1863 Paul Broca reported on his development of the “craniograph,” which he used to identify cortical anatomy via surface landmarks. This prototypical stereotactic device was built of wood. Broca sought someone who could construct an iron version of his invention, and noted near the end of his report that “M. Mathieu, maker of surgical instruments in Paris, builds craniographs that are most elegant.”
So industry has served the advance of neurosurgery well. Still, you may wish to consider Cushing’s words as he began his introduction of the Bovie: “I confess to have been somewhat skeptical about the adaptability of this new procedure to my own purposes.”
Michael Schulder, MD, is associate professor in the Department of Neurological Surgery and director of Image-Guided Neurosurgery at UMDNJ-New Jersey Medical School.