Endoscopic microneurosurgery: usefulness and cost-effectiveness in the consecutive experience of 210 patients

Indications, usefulness, and cost-effectiveness of the endoscope in routine microneurosurgery are not clear. To delineate such aspects, we assessed our experience of endoscopic application and additional cost to use an endoscope.

Endoscopes were used in 210 patients with cranial base and cisternal pathological features in the previous 7 years. Lesions were located in the extradural cranial base in 78 patients and in the cistern in 132 patients. Rigid lens endoscopes 2.7 to 4 mm in width, 11 to 20 cm in length, and 0 to 70 degrees in angle were used.

Endoscopes were used for primary or a significant part of the surgery in 64% of the extradural cranial base procedures. Although endoscopes were used only for visual assistance in 82% of cisternal pathological features, significant benefit was noted in 9% and was not different from cranial base lesions. Eleven patients may have had complications if the endoscope had not been used, and 10 procedures would have been impossible without endoscopic use. Therefore, the number of patients need to treat to experience significant benefits by endoscope was 10. Endoscopic equipment costs an additional US $326 per patient and, hence, significant benefit was the equivalent of US $3260. No permanent complications resulted from the use of the endoscope.

The endoscope can be applied safely in routine microsurgery with specific equipment and has proven useful in 1 of 10 patients. To perform more effective procedures using endoscopes, we need to develop specially designed instruments usable through a narrow corridor and in an angled field.