The future role of neurosurgery in medicine.

Illustrated by several examples from the past it is demonstrated how difficult it is to predict future developments in neurosurgery. Several determinants can be recognized as exerting a positive or a negative influence in this respect. Careful observation of unexpected events and consequent consideration in combination with a spiritual independency, are aspects which will contribute in a positive way. The reverse will unavoidably lead to abolition of new ideas and concepts. Authority in a personal as well as in an impersonal way, may act as a negative determinant. This aspect is illustrated by some examples regarding the phenomenon of the "medical mandarin" as a personal authority, and the irrational adherence to paradigms as an impersonal one. Based upon recent experiments new ways for neurosurgical activities are indicated, concerning 1st transplantation of fetal central nervous tissue and of adrenal medullary tissue, and 2nd deep long-term stimulation of the beta endorphin-serotonin system for the control of chronic pain.