Tailored concept for accurate neuroendoscopy: a comparative retrospective single-center study on image-guided neuroendoscopic procedures - technical note.

OBJECTIVE: Precise planning and execution is key for neuroendoscopic interventions which may be based on different available aiding technologies. The aim of this retrospective study is to report a case-based utilization of guided neuroendoscopy and to develop a stratification algorithm for the available technologies.

METHODS: We reviewed consecutive neuroendoscopic cases performed at our center from 2016 to 2018. We distinguished between patients receiving a new burr hole (group A) from cases with preexisting burr hole (group B). Case specific technical requirements for procedure planning and execution, complication rate, surgical outcome, and possible subsequent surgeries were evaluated. From this experience a stratification system was developed to tailor available guiding technologies.

RESULTS: 309 neuroendoscopic interventions in 243 patients were included in the study. Cases included hydrocephalic (81.6%) and non-hydrocephalic (18.4%) conditions. The interventions were supported either by coordinate-based (CB: group A n=49; group B n=67), guide-based (GB: group A n=42; group B n=0), ultrasound-assisted (UG: group A n=50; group B n=7) or augmented reality-navigated (NAR: group A n=85; group B n=9) techniques, respectively. Overall complication rate was at 4.5%. Depending on surgical indication, fontanel status, entry point localization, preexisting burr hole, ventricular size, and number of targets a stratified approach towards image-guided neuroendoscopy is suggested.

CONCLUSIONS: Planning and technical guidance is of essential in neuroendoscopic procedures. The stratified decision making algorithm for different available technologies aimed to achieve lower cost and time consumption, which was experienced to be safe and efficient. Further investigation are warranted to deliver solid data on procedure efficiency.