Related Experiment Video
Updated: Sep 27, 2026
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Practical Indications and Intraoperative Contribution of Neuroendoscopic Assistance During Exoscopic Skull Base
Fumihiro Matano1, Miku Tsuruya1, Satsuki Imaoka1
1Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
Background:
Neuroendoscopy complements exoscopic visualization by providing angled views of anatomical structures hidden from the direct surgical line of sight. However, its practical indications and intraoperative contribution during exoscope-assisted skull base surgery have not been systematically evaluated. This study aimed to characterize the patterns of neuroendoscopic use and its observed intraoperative contribution during exoscope-assisted skull base surgery.
Methods:
We retrospectively reviewed 164 consecutive skull base procedures performed between March 2024 and June 2026. After excluding 58 pure endoscopic endonasal procedures, 106 exoscope-assisted procedures were analyzed. Neuroendoscopic assistance was used in 42 procedures, each performed in a different patient. Complete operative video recordings from these 42 procedures were retrospectively reviewed by two neurosurgeons, and the observed contribution of neuroendoscopy was classified as visualization-only, confirmatory, or decision-changing.
Results:
Neuroendoscopic assistance was used in 42 of 106 exoscope-assisted procedures (39.6%), including 30 aneurysms and 12 tumors. The most common indication was clip and perforator confirmation during aneurysm surgery (30/42, 71.4%). The observed contribution was classified as visualization-only in 8 procedures (19.0%), confirmatory in 20 (47.6%), and decision-changing in 14 (33.3%). Among the 14 decision-changing procedures, neuroendoscopic findings led to clip repositioning in 5 aneurysm procedures and additional tumor removal in 9 tumor procedures. No complications judged attributable to neuroendoscope insertion or manipulation were identified in the 42 procedures.
Conclusions:
Neuroendoscopic assistance provided additional intraoperative information during exoscope-assisted skull base surgery, with decision-changing findings identified in 14 of 42 assisted procedures. These findings characterize the observed contribution and practical indications of neuroendoscopic assistance; however, the retrospective design, selective use of neuroendoscopy, and limited sample size preclude conclusions regarding comparative efficacy or safety.
