[Building High-Quality Evidence in Endoscopic Neurosurgery : Practical Clinical Research Strategies and Multicenter...

Endoscopic neurosurgery has advanced rapidly over the past three decades and now represents a core minimally invasive approach in modern neurosurgical practice. Despite technical progress, high-certainty evidence has often lagged, partly because outcome variability is driven not only by disease characteristics but also by procedure-specific complexity, surgeon proficiency, learning curves, and institution-dependent factors such as multidisciplinary team structure and perioperative workflows. This study provides a practical framework for building reproducible clinical evidence in endoscopic neurosurgery. We highlight (1) the design of high-quality clinical databases and the deliberate selection of electronic data capture (EDC) platforms to ensure standardization, completeness, auditability, and future reanalysis; (2) team-based infrastructure and governance, including clearly defined roles (e.g., surgeons, ENT collaborators, coordinators, data managers, biostatisticians) and multicenter mechanisms for oversight, data coordination, and formalized data-sharing agreements and quality-control procedures; and (3) analytical strategies for bias control, integrating appropriate statistical testing with survival analysis, multivariable modeling, propensity-based methods, effect size reporting, and learning-curve evaluation. By aligning robust data infrastructure, effective governance, and rigorous analytical methods, endoscopic neurosurgery can progress beyond anecdotal experience toward transparent, reproducible, and generalizable clinical evidence that informs clinical practice, training, and patient safety.