Neurosurgeons and ideas before their time.

As a complementary inquiry to previous studies on citation analysis in neurosurgery, a group of ideas before their time has been arbitrarily selected by the author from 3792 first-authored papers written between 1897 and 1980 by 50 of the first American neurosurgeons. There were eight neurosurgeons who proposed 12 original theories or procedures whose importance was not recognized at the time of publication. Although the value of these ideas was not initially judged to be significant, these concepts became a part of the intellectual consensus of neurosurgery or related disciplines after varying periods of time. Technical constraints constituted the most important reason for delayed recognition of these innovative and creative ideas. Other factors were an unsuitable medium of communication, fixed scientific attitudes, prestige of previous authors, incomplete literature review by later authors, and a failure to verify observations by other investigators. The question is raised as to whether these factors might continue to affect present and future clinical investigation and laboratory research in neurosurgery.