Surgical microscopes entered neurosurgical practice only decades after other surgical disciplines, such as ophthalmology and otology. Becoming standard tools in the 1970s, they effectively transformed the discipline into “microneurosurgery”. This transformation prompted powerful changes, such as reducing overall mortality and making the brain’s pervasive, smaller blood vessels surgically accessible. At the same time, it led to the reorganization of surgical training, knowledge, and the surgical room.
This paper examines how early users of microscopes in Zurich and Los Angeles acted as translators between the past and the high-technology future. Only around forty years earlier, neurosurgeons had asserted their independence by enforcing exacting epistemic virtues such as fastidiousness, self-restraint, and elitism. Accomplished neurosurgeons often passively opposed microsurgery, maintaining these virtues, relying on their standing, proven approaches, and building on their existing skills. In contrast, early adopters successfully promoted the surgical microscope, demonstrating how these new approaches could align with the meticulous, laborious surgical style already valued in the discipline. They increasingly relied on laboratory training and showcased the safety and reliability of their techniques through new media, including CCTV, video, and photography.
Furthermore, existing surgical and clinical needs had to be translated into adaptations of existing surgical microscopes designed for other disciplines, and co-designing a range of auxiliaries to make the surgical microscope work in neurosurgery. To this end, surgeons worked closely with traditional and emerging med-tech industries.
This paper therefore frames neurosurgery’s shift to microsurgery as an epistemological transformation that required the translation of traditional values, skills, and professional hierarchies into a new technologically mediated operative environment.