Intraventricular and Skull Base Neuroendoscopy in 2012: A Global Survey of Usage Patterns and the Role of Intraoperative Neuronavigation

BACKGROUND: During the past decade, endoscopic intraventricular and skull base operations have become widely used for a variety of evolving indications. A global survey of practicing endoscopic neurosurgeons was performed to characterize patterns of usage regarding endoscopy equipment, instrumentation, and the indications for using image-guided surgery systems (IGSs). METHODS: An online survey consisting of 8 questions was completed by 235 neurosurgeons with endoscopic surgical experience. Responses were entered into a database and subsequently analyzed. RESULTS: The median number of operations performed per year by intraventricular and skull base endoscopic surgeons was 27 and 25, respectively. Data regarding endoscopic equipment brand, diameter, and length are presented. The most commonly reported indications for IGSs during intraventricular endoscopic surgery were tumor biopsy/resection, intraventricular cyst fenestration, septostomy/pellucidotomy, endoscopic third ventriculostomy, and aqueductal stent placement. Intraventricular surgeons reported using IGSs for all cases in 16.6% and never in 24.4%. Overall, endoscopic skull base surgeons reported using IGSs for all cases in 23.9% and never in 18.9%. The most commonly reported indications for IGSs during endoscopic skull base operations were complex sinus/skull base anatomy, extended approaches, and reoperation. CONCLUSIONS: Many variations and permutations for performing intraventricular and skull base endoscopic surgery exist worldwide. Much can be learned by studying the patterns and indications for using various types of equipment and operative adjuncts such as IGSs.