title: Evolution in practice: how has British neurosurgery changed in the last 10 years?
abstract: BACKGROUND
  Neurosurgery is a fast-evolving surgical subspecialty driven by technological advances, socio-economic factors and patient expectations. In this study, we have compared the work-load volume in a single institution in the years of 1994 and 2004 and commented on the possible reasons for the changes and the impacts they may have for the future.
  
  
  METHODS
  A retrospective, log-book review of all operations performed in the years 1994 and 2004 in a single, tertiary, neurosurgical centre was performed.
  
  
  RESULTS
  Neurosurgical practice has evolved over this period. Current practice has moved away from clipping of aneurysms and towards coil embolisation performed by interventional radiologists. Electrode stimulation of deep brain regions for movement disorders is the current practice, whereas 10 years ago the same disorders were dealt with by lesioning of the relevant regions. In spinal neurosurgery, instrumentation is increasingly favoured currently. In the field of neuro-oncology, current practice favours minimal access to the target area by the use of stereotactic localisation.
  
  
  CONCLUSIONS
  Changes were most pronounced in the subspecialties of vascular, functional and spinal neurosurgery within this 10-year period. Knowledge of such dynamics is valuable in health resource management as well as planning for neurosurgical training programmes.
authors.affiliation: Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK. andrew.tarnaris@uclh.nhs.uk
authors.forename: A
authors.initials: A
authors.lastname: Tarnaris
authors.forename: B
authors.initials: B
authors.lastname: Arvin
authors.forename: K
authors.initials: K
authors.lastname: Ashkan