Smartphone-assisted minimally invasive neurosurgery


Open access paper Smartphone-assisted minimally invasive neurosurgery, by Mandel et al. Journal of Neurosurgery (2018)


Advances in video and fiber optics since the 1990s have led to the development of several commercially available high-definition neuroendoscopes. This technological improvement, however, has been surpassed by the smartphone revolution. With the increasing integration of smartphone technology into medical care, the introduction of these high-quality computerized communication devices with built-in digital cameras offers new possibilities in neuroendoscopy. The aim of this study was to investigate the usefulness of smartphone-endoscope integration in performing different types of minimally invasive neurosurgery.

The authors present a new surgical tool that integrates a smartphone with an endoscope by use of a specially designed adapter, thus eliminating the need for the video system customarily used for endoscopy. The authors used this novel combined system to perform minimally invasive surgery on patients with various neuropathological disorders, including cavernomas, cerebral aneurysms, hydrocephalus, subdural hematomas, contusional hematomas, and spontaneous intracerebral hematomas.

The new endoscopic system featuring smartphone-endoscope integration was used by the authors in the minimally invasive surgical treatment of 42 patients. All procedures were successfully performed, and no complications related to the use of the new method were observed. The quality of the images obtained with the smartphone was high enough to provide adequate information to the neurosurgeons, as smartphone cameras can record images in high definition or 4K resolution. Moreover, because the smartphone screen moves along with the endoscope, surgical mobility was enhanced with the use of this method, facilitating more intuitive use. In fact, this increased mobility was identified as the greatest benefit of the use of the smartphone-endoscope system compared with the use of the neuroendoscope with the standard video set.

Minimally invasive approaches are the new frontier in neurosurgery, and technological innovation and integration are crucial to ongoing progress in the application of these techniques. The use of smartphones with endoscopes is a safe and efficient new method of performing endoscope-assisted neurosurgery that may increase surgeon mobility and reduce equipment costs.

Intraventricular neuroendoscopy with the use of a smartphone for aqueductal stenosis in a 6-month-old male infant, in whom an abnormal progressive increase in head circumference had developed since birth. A: Photograph obtained during surgery with an MR image of the brain demonstrating hydrocephalus due to idiopathic aqueductal stenosis (red arrow in inset). The endoscopic procedure is performed in a standard manner except for the addition of the iPhone attached to the endoscope, which provided a viewing screen that allowed the surgeon’s gaze to remain on the surgical field. B–E: The iPhone provided the surgeon with endoscopic views of the foramen of Monro (B), an ideal spot for fenestration (C and D), and the final aspect of the field (E). The 4K camera resolution allows adequate visualization of perforating arteries, thus allowing the surgeon to avoid causing inadvertent injuries. After this surgery the patient progressed well with no need for additional procedures.