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Bharath Raju, Fareed Jumah, Vinayak Narayan, Anika Sonig, Hai Sun, and Anil Nanda

The earliest evidence of man’s attempts in communicating ideas and emotions can be seen on cave walls and ceilings from the prehistoric era. Ingenuity, as well as the development of tools, allowed clay tablets to become the preferred method of documentation, then papyrus and eventually the codex. As civilizations advanced to develop structured systems of writing, knowledge became a power available to only those who were literate. As the search to understand the intricacies of the human brain moved forward, so did the demand for teaching the next generation of physicians. The different methods of distributing information were forced to advance, lest the civilization falls behind. Here, the authors present a historical perspective on the evolution of the mediums of illustration and knowledge dissemination through the lens of neurosurgery. They highlight how the medium of choice transitioned from primitive clay pots to cutting-edge virtual reality technology, aiding in the propagation of medical literature from generation to generation across the centuries.

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Michael T. C. Poon, Jorge Gaete-Villegas, Paul M. Brennan, and Jacques Fleuriot

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Bharath Raju, Fareed Jumah, Omar Ashraf, Vinayak Narayan, Gaurav Gupta, Hai Sun, Patrick Hilden, and Anil Nanda

Big data has transformed into a trend phrase in healthcare and neurosurgery, becoming a pervasive and inescapable phrase in everyday life. The upsurge in big data applications is a direct consequence of the drastic boom in information technology as well as the growing number of internet-connected devices called the Internet of Things in healthcare. Compared with business, marketing, and other sectors, healthcare applications are lagging due to a lack of technical knowledge among healthcare workers, technological limitations in acquiring and analyzing the data, and improper governance of healthcare big data. Despite these limitations, the medical literature is flooded with big data–related articles, and most of these are filled with abstruse terminologies such as machine learning, artificial intelligence, artificial neural network, and algorithm. Many of the recent articles are restricted to neurosurgical registries, creating a false impression that big data is synonymous with registries. Others advocate that the utilization of big data will be the panacea to all healthcare problems and research in the future. Without a proper understanding of these principles, it becomes easy to get lost without the ability to differentiate hype from reality. To that end, the authors give a brief narrative of big data analysis in neurosurgery and review its applications, limitations, and the challenges it presents for neurosurgeons and healthcare professionals naive to this field. Awareness of these basic concepts will allow neurosurgeons to understand the literature regarding big data, enabling them to make better decisions and deliver personalized care.

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Kanwaljeet Garg, Ravi Sharma, Amol Raheja, Vivek Tandon, Varidh Katiyar, Chinmaya Dash, Rishi Bhatnagar, Mohan Kumar Khullar, Bharath Raju, Anil Nanda, and Shashank S. Kale


Despite the rising trend of medicolegal challenges in India, there is an absolute dearth of literature from India on this issue. The authors conducted a survey, to their knowledge a first of its kind, to assess the perceptions of Indian neurosurgeons about the medicolegal challenges faced in everyday practice.


An anonymous online survey performed using Google Forms was widely circulated among neurosurgeons practicing in India via email and social media platforms. The questionnaire consisted of 38 questions covering the various aspects of medicolegal issues involved in neurosurgery practice.


A total of 221 survey responses were received, out of which 214 responses were included in the final analysis, barring 7 responders who had no work experience in India. The respondents were categorized according to their working arrangements and work experience. Out of all of the respondents, 20 (9.3%) had ≥ 1 malpractice suits filed against them. More than 90% of the respondents believed that malpractice suits are on the rise in India. Almost half of the respondents believed the advent of teleconsultation is further compounding the risk of malpractice suits, and 66.4% of respondents felt that they were inadequately trained during residency to deal with medicolegal issues. Most respondents (88.8%) felt that neurosurgeons working in the government sector had lesser chances of facing litigations in comparison to those working in the private sector. The practice of obtaining video proof of consent was more commonly reported by respondents working in freelancing and private settings (45.1%) and those with multiple affiliations (61.3%) compared to respondents practicing in government settings (22.8%) (p < 0.001). Neurosurgeons working in the private sector were more likely to alter management and refer sick patients to higher-volume treatment centers to avoid malpractice suits than their government counterparts (p = 0.043 and 0.006, respectively). The practices pertaining to legal preparedness were also found to be significantly higher among the respondents from the private sector (p < 0.001).


This survey highlights the apprehensions of neurosurgeons in India with regard to rising malpractice suits and the subsequent increase of defensive neurosurgical practices, especially in the private sector. A stronger legal framework for providing for quick redress of patient complaints, while deterring frivolous malpractice suits, can go a long way to allay these fears. There is a dire need for systematic training of neurosurgeons regarding legal preparedness, which should begin during residency.