Operating on the self-power, intimacy, and personhood in neurosurgery

Neurosurgery occupies a unique position in medicine because it intervenes directly on the biological basis of thought, behavior, and identity. While ethical discussions often focus on surgical risks and functional outcomes, less attention is given to how such interventions may affect a patient’s sense of self. In this correspondence, we argue that neurosurgical practice involves underexamined dimensions of power, asymmetry, and uncertainty. Through examples such as deep brain stimulation and awake craniotomy, we highlight how technically successful procedures can still result in changes to personality, relationships, and self-perception. We suggest that current approaches to informed consent and clinical decision-making do not fully account for these possibilities. Recognizing the limits of technical knowledge and the potential for transformation is essential for more meaningful consent, greater ethical awareness, and a form of professionalism that remains accountable not only to outcomes but to the person undergoing them.