In the literature, we miss a systematic presentation of the advances in neurosurgery since Harvey Cushing. What expansion of our knowledge about the fundamentals did physiology bring? How confidently can we today adjust temperature and circulation to meet the requirements of brain metabolism after trauma or during and after surgeries? Many phenomena, which are still predominantly viewed morphologically, have received new successful interpretations through a more pathophysiological perspective. Endocrinological research has provided significant new insights for diagnostics and therapy beyond pituitary adenomas. The use of contrast methods—both in terms of their safer applicability and their diagnostic reliability—has contributed to a substantial improvement in the classification of tumors.