title: Endoscope Holders in Cranial Neurosurgery: Part I-Technology, Trends, and Implications.
abstract: OBJECTIVE
  Cranial neuroendoscopy is becoming increasingly popular. Endoscopes may be used free-hand or with endoscope holders (EH). The aim of this paper is to summarize the evolution of EH and attempt an overview of currently available devices, features, and usage, identifying weaknesses and focusing on feasibility.
  
  
  METHODS
  A systematic review was conducted on Pubmed, OvidSP, Ebsco, and Google Scholar. Targeted search through cross-references was also implemented, followed by personal contacts, interviews, company websites, and operating manuals. A pilot survey was performed to acquire an impression of the current state of usage. This was conducted by approaching surgeons from several countries via e-mail and online through a neurosurgical exchange forum. A more extensive survey will follow as Part II.
  
  
  RESULTS
  EH may be divided into manual and pneumatic. The use of micromanipulators is sometimes implemented. Different characteristics have been described, such as pneumatic, mechanical, friction, micromanipulator, robotic, hybrid, air-locking, and voice-control. Twenty eight surgeons responded. The majority (75%) do not routinely use EH. The rest use EH mainly for intraventricular rather than skull base procedures. Nearly all surgeons (96%) stated using a second surgeon regularly. Reported weaknesses included crude movements, downward drift, loss of depth perception, lack of flexibility, iatrogenic injury, cost, and bulky construction.
  
  
  CONCLUSIONS
  Although EH have a role in neuroendoscopy, their use seems to be limited and their features regarded as suboptimal. There are no clear indications regarding the procedures that should be performed using EH. Many factors affect the implication of EH, including safety, type of surgery, surgeon's preference, and mechanical properties.
authors: Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, United Kingdom. Electronic address: dimitris.parask@gmail.com.
authors: Dimitrios
authors: D
authors: Paraskevopoulos
authors: Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors: Jonathan
authors: J
authors: Roth
authors: Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors: Shlomi
authors: S
authors: Constantini
mesh_terms: D006801:Humans; D044583:Neuroendoscopy / Q000295:instrumentation*; D010865:Pilot Projects; D011795:Surveys and Questionnaires
keywords: Endoscope; Holding device; Minimally invasive surgery; Neuroendoscopy; Skull base; Ventricular surgery