Neurosurgery in France: Evolution for 30 years, Perspectives and Current Issues

Neurosurgery has undergone profound changes over the past 30 years. Advances in imaging have made it possible to improve the diagnosis of many pathologies and to carry out operative planning combining both morphological and functional data. Neuronavigation, surgery in awake conditions and intraoperative imaging techniques (scanner, ultrasound, MRI) have improved the precision of interventions. Minimally invasive approaches, made possible in particular thanks to endoscopy, have reduced the complications of surgery and accelerated postoperative recovery. In the tumoral pathology, the contribution of complementary treatments (radiotherapy, chemotherapy) has modified the surgical objectives, authorizing less dilapidating gestures which have improved the functional prognosis and the quality of life of the patients. Spinal surgery has seen the rise of instrumented surgeries. The development of interventional neuroradiology has diminished and modified the indications in vascular neurosurgery. In functional neurosurgery, neuromodulation has sought to restore function without causing damage.
In the decades to come, artificial intelligence and robotic surgery will allow us to further improve our diagnostics and surgical procedures. It will also be necessary to meet the demographic challenges of a stressful and demanding specialty by taking into account the different modes of exercise, public and private, and the demand for a better quality of life of the generations in training.