Endoscope Holders in Cranial Neurosurgery: Part I-Technology, Trends, and Implications

Cranial neuroendoscopy is becoming increasingly popular. Endoscopes may be used free-hand or with endoscope holders (EH). The aim of this paper is to summarize the evolution of EH and attempt an overview of currently available devices, features, and usage, identifying weaknesses and focusing on feasibility.

A systematic review was conducted on Pubmed, OvidSP, Ebsco, and Google Scholar. Targeted search through cross-references was also implemented, followed by personal contacts, interviews, company websites, and operating manuals. A pilot survey was performed to acquire an impression of the current state of usage. This was conducted by approaching surgeons from several countries via e-mail and online through a neurosurgical exchange forum. A more extensive survey will follow as Part II.

EH may be divided into manual and pneumatic. The use of micromanipulators is sometimes implemented. Different characteristics have been described, such as pneumatic, mechanical, friction, micromanipulator, robotic, hybrid, air-locking, and voice-control. Twenty eight surgeons responded. The majority (75%) do not routinely use EH. The rest use EH mainly for intraventricular rather than skull base procedures. Nearly all surgeons (96%) stated using a second surgeon regularly. Reported weaknesses included crude movements, downward drift, loss of depth perception, lack of flexibility, iatrogenic injury, cost, and bulky construction.

Although EH have a role in neuroendoscopy, their use seems to be limited and their features regarded as suboptimal. There are no clear indications regarding the procedures that should be performed using EH. Many factors affect the implication of EH, including safety, type of surgery, surgeon's preference, and mechanical properties.