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The First Brain Tumour Surgical Procedure

Precision, care and minimal invasion are at the core of successful neurosurgery, which means that surgeons who specialise in operations surrounding the brain, spinal cord and nervous system are amongst the best in the world. The greatest advancements, most cutting-edge technologies and most precise tools in all of medicine are typically first used to make neurosurgery even safer and more precise, as well as reduce the necessity for more invasive procedures. Treating certain benign brain tumours has over the course of a century evolved from requiring an invasive surgical procedure to an outpatient procedure that despite being known as stereotactic radiosurgery, involves no surgical incisions whatsoever. Getting to this modern, advanced field was the result of thousands of years of research by pioneers in the field of medicine, working in far from the best conditions without the working knowledge or the technology we have now. The biggest watershed moment for brain surgery took place in 1879, nearly 150 years ago, and was a fitting turning point when surgery finally became a science.

The First Successful Neurosurgery

Strictly speaking, neurosurgery dates as far back as prehistoric times, and the first surgical procedures and tools that we have archaeological evidence for involved the head and the brain. This was the practice of trepanation, where a hand-operated cranial drill was used to bore a hole into the skull. Whilst this was typically done for ritualistic purposes and had the level of risk one might expect from prehistoric surgery, there were conditions such as subdural haematoma where a hole in the skull could relieve pressure on the brain, relieving pain and reducing the risk of further injury. Evidence of trepanation is found most commonly on sites with evidence of blunt weaponry, lending credibility to theories that trepanation was also used as an emergency surgery after someone suffered a serious head injury. Whilst some advances in theoretical neurological knowledge existed in early civilisations, it would take until the Renaissance for wider anatomical knowledge to be disseminated and until the 19th century before this knowledge would be put into practice.

The First Brain Tumour Surgery

The 19th century was the turning point for the entire medical field, but especially surgery, with the development of antiseptics by Joseph Lister, having been inspired by the work of Louis Pasteur. Before this, any surgical procedure was complicated by the risk and significant consequences of infection, but after Lord Lister’s practices started to be widely adopted, surgery would evolve rapidly and fundamentally shift. One of the first people to take what is now standard medical practice seriously was Sir William Macewan, a Scottish surgical pioneer who innovated in many different surgical fields. However, aside from his advancements in anaesthesia, bone grafts and lung surgery, his greatest achievements were found in neurosurgery and the treatment of brain tumours and brain abscesses. Before the development of X-rays and other diagnostic equipment, Mr Macewen believed that through observation of motor functions and the reactions of the senses of a patient, a brain surgeon could determine the location of a lesion or tumour. He first demonstrated this in 1876 by using his techniques to diagnose that a boy was suffering from an abscess in his frontal lobe, something that was tragically confirmed by autopsy after his parents refused their permission to allow him to operate. Three years later, a teenage girl with epileptic symptoms was determined by Mr Macewan to have some kind of growth on their left frontal lobe. With permission to perform surgery this time, Mr Macewan found a large meningeal tumour in the area he had suggested, and excised it, completing the first-ever brain surgery in the process. What is somewhat unique is that Mr Macewan used a process similar to trepanation, drilling a hole into the skull and operating outside of the brain to remove as much of the tumour as he could. The girl lived for eight more years and after she died, a resulting autopsy found no trace of the tumour, showing the efficacy of the procedure. The first primary brain tumour operation, where the skull was opened, an incision was made into the brain itself and the tumour excised was performed by Sir Rickman Godlee, after the tumour was diagnosed and located by Alexander Bennet. This case, reported at the time as the very first of its kind, generated considerable interest, proving to be an incredibly important moment in the history of brain surgery, in part due to its complexity but also because of how widely publicised the procedure was. In the century since this operation, neurosurgery has evolved exponentially, but these two treatments served as the turning point.

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