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. 2017 Oct;159(10):1957-1966.
doi: 10.1007/s00701-017-3280-3. Epub 2017 Aug 6.

Innovation in neurosurgery: less than IDEAL? A systematic review

I S Muskens  1   2 , S J H Diederen  1 , J T Senders  1   2 , A H Zamanipoor Najafabadi  3 , W R van Furth  3 , A M May  4 , T R Smith  2 , A L Bredenoord  5 , M L D Broekman  6   7
Affiliations

Innovation in neurosurgery: less than IDEAL? A systematic review

I S Muskens et al. Acta Neurochir (Wien). 2017 Oct.

Abstract

Background: Surgical innovation is different from the introduction of novel pharmaceuticals. To help address this, in 2009 the IDEAL Collaboration (Idea, Development, Exploration, Assessment, Long-term follow-up) introduced the five-stage framework for surgical innovation. To evaluate the framework feasibility for novel neurosurgical procedure introduction, two innovative surgical procedures were examined: the endoscopic endonasal approach for skull base meningiomas (EEMS) and the WovenEndobridge (WEB device) for endovascular treatment of intracranial aneurysms.

Methods: The published literature on EEMS and WEB devices was systematically reviewed. Identified studies were classified according to the IDEAL framework stage. Next, studies were evaluated for possible categorization according to the IDEAL framework.

Results: Five hundred seventy-six papers describing EEMS were identified of which 26 papers were included. No prospective studies were identified, and no studies reported on ethical approval or patient informed consent for the innovative procedure. Therefore, no clinical studies could be categorized according to the IDEAL Framework. For WEB devices, 6229 articles were screened of which 21 were included. In contrast to EEMS, two studies were categorized as 2a and two as 2b.

Conclusion: The results of this systematic review demonstrate that both EEMS and WEB devices were not introduced according to the (later developed in the case of EEMS) IDEAL framework. Elements of the framework such as informed consent, ethical approval, and rigorous outcomes reporting are important and could serve to improve the quality of neurosurgical research. Alternative study designs and the use of big data could be useful modifications of the IDEAL framework for innovation in neurosurgery.

Keywords: Ethics; IDEAL framework; Innovation; Intracranial aneurysm; Meningioma; Neurosurgery; WEB device.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no competing interests.

Disclosures

IM received funding from the KNAW to present the content of this manuscript at the 2017 AANS meeting in Los Angeles.

Funding

No funding.

Human and animal consent

This article does not contain any studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
a Flowchart of the study selection process of included articles on endoscopic endonasal meningioma resection. b Flowchart of the study selection process of included articles on WEB devices
Fig. 1
Fig. 1
a Flowchart of the study selection process of included articles on endoscopic endonasal meningioma resection. b Flowchart of the study selection process of included articles on WEB devices
See this image and copyright information in PMC

Comment in

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