Neurosurgery, demands a commitment to preserving a patients identity in the face of (at times) impossible odds. This can be preventing secondary neurological damage in cases of traumatic brain injuries, e.g. accidents giving patients devastating brain bleeds, which requires quick and decisive operations on the brain to grant an opportunity to prevent worsening neurological damage from the initial primary injury to a) save life and b) ensure a patient has enough capacity for rehabilitation.

Naturally, this is not always possible as some traumatic brain injuries despite best efforts result in death (or serious disability) even if every single part in the patient journey from the 999 call to neurosurgical operation is done in a seamless and thorough manner. However, trauma is more easily understood than non-traumatic cases, e.g. elective cases, which involve benign and malignant tumours, hydrocephalus and CSF disorders, diseases of the arteries and veins in and around the brain and spinal cord, and degenerative spinal conditions.

Essentially, operating on the brain and spinal cord is inherently dangerous. Why? Because neurosurgeons cannot manipulate anatomical structures in brain and spinal cord tissue in 3D space as surgeons can in other specialities, e.g. a general surgeon can manually hold colon up to inspect it prior to cutting, but if a neurosurgeon were to hold a piece of brain tissue (or spinal cord) up to the light, these parts that constitute your consciousness, then catastrophic damage would result. So we operate in a manner unlike every other surgical specialty. 

If you factor in the myriad arrangement of blood vessels and their propensity to cause serious neurological injury (even if not directly touched) then straightforward neurosurgical operations can (and have) ended in complication. Just read Do NoHarm by Henry Marsh for context. This is something every neurosurgical trainee sees and this should give caution each time one consents and operates on a patient.

Why? Because there is nothing as a straightforward neurosurgical operation and complications can occur in a heart beat during an operation (or occur in a manner no one predicts over a period of days, weeks, months and years). The consent process in neurosurgery is complicated but one thing above all is to be honest and truthful about if operating is truly necessary. What distinguishes all surgical operations is that it involves a progression of steps which are irreversible.