Nav: Home

Smartphone-assisted neuroendoscopy

March 13, 2018

Charlottesville, VA (March 13, 2018). Smartphones have changed the ways in which we live. They connect us with friends and families by phone, texts, and pictures. They warn us about what weather to expect and what traffic patterns we'll face on our way to work. They keep us abreast of all the news of the day and in touch with colleagues and clients.

Here's another item we can add to the list: smartphones can assist neurosurgeons in performing intricate surgeries. In a paper published today in the Journal of Neurosurgery, "Smartphone-assisted minimally invasive neurosurgery," Mauricio Mandel, MD, and colleagues from São Paulo, Brazil, describe a smartphone-endoscope device for use in minimally invasive neurosurgery. These authors found the device easy to use, efficient, cost effective, and a great learning tool for less experienced neurosurgeons.


Neuroendoscopy is a minimally invasive neurosurgical procedure performed in select cases to correct hydrocephalus, remove tumors, treat vascular disease, and manage other disorders. Neuroendoscopic procedures generally result in less pain, shorter recovery times, and less scarring than craniotomy (open surgery).

During the neuroendoscopic procedure, a rigid or flexible neuroendoscope is inserted through a small incision in the skull, nose, or roof of the mouth and moved on to the planned surgical site in the brain, ventricles, or subdural or subarachnoid spaces. The neuroendoscope contains a light source to illuminate the surgical field, a lens for magnification, and a camera, which sends images to a nearby video monitor so that surgeons can see where they are operating. The neuroendoscope also contains channels and ports through which surgeons can insert and maneuver endoscopic instruments and irrigate the surgical site.

Present Study

In this paper, the authors describe their experiences in performing a variety of neurosurgical procedures with the aid of smartphone-endoscope integration: intraventricular procedures, such as treatment for hydrocephalus; vascular neurosurgery, such as aneurysm clipping or cavernoma resection; and emergency neurosurgery, such as evacuation of a subdural or intracranial hematoma. The authors demonstrate how a smartphone takes the place of the video camera usually used in neuroendoscopy and makes the presence of a separate video monitor optional.

During minimally invasive surgeries performed in 42 patients, a fully charged smartphone (iPhone models 4, 5, and 6) was attached to the front of the neuroendoscope by means of an adapter. The primary surgeon focused directly on the iPhone screen in front of him or her, rather than off to one side where the video monitor normally stands. The smartphone relayed images from the screen via Wi-Fi to a video monitor placed elsewhere in the operating room.

The video monitor remained in the operating room so that other members of the surgical team could view the procedure or in case the primary surgeon wished to revert to more conventional neuroendoscopy. The surgeons who tested the smartphone-endoscope device found images provided by the smartphone to be sufficient and did not switch to the conventional method.

In each case the device worked well. All surgeries were successful, and no complications related to use of the smartphone occurred.

Based on their experience, the authors list several advantages of using smartphone-assisted neuroendoscopy:
  • The smartphone is light-weight and small. It attaches easily to the endoscope by means of an adapter.
  • Despite the small size of the smartphone screen, its high-definition image provides an excellent view of the surgical site.
  • The smartphone camera supports real-time video acquisition, storage, and transmission via a variety of wireless technologies (Wi-Fi, 4G, Bluetooth, etc.). Images viewed by the primary surgeon can be simultaneously shared with the rest of the operative team on a video monitor, streamed directly to other colleagues or websites, and recorded for review and teaching purposes.
  • Images can be manipulated in real time using camera functions on the smartphone.
  • Compared with standard video equipment, smartphones are cheaper, more portable, and do not require an external power source. Should the battery become depleted during a prolonged surgery, the smartphone can be recharged without an interruption in the procedure.
  • Having the smartphone screen directly in front of the primary surgeon allows "a more dynamic and intuitive approach to resection" than can be experienced when a surgeon has to look away from the endoscope being manipulated to view the surgical field on a separate video monitor.
  • The learning curve for neurosurgical residents less experienced in neuroendoscopy is reduced when the smartphone is used.

The authors recognize that their study is preliminary and the number of cases is low. Nevertheless, they suggest that the smartphone-endoscope device may provide an alternative method of performing neuroendoscopy. The relatively inexpensive costs of a smartphone and adapter could prove beneficial in underserved areas and in countries whose medical infrastructure cannot support expensive equipment.

When asked about the study, Dr. Mandel said, "The most interesting aspect of this project was that our initial goal was to reduce the cost of the neuroendoscopic video set, but, in the end, we came across a new, more intuitive and fluid method of performing these procedures."
Mandel M, Petito CE, Tutihashi R, Paiva W, Abramovicz Mandel S, Pinto FCG, Ferreira de Andrade A, Teixeira MJ, Figueiredo EG . Smartphone-assisted minimally invasive neurosurgery. Journal of Neurosurgery, published online, ahead of print, March 13, 2018; DOI: 10.3171/2017.6.JNS1712.

The authors are affiliated with the Division of Neurosurgery, Hospital das Clínicas of University of São Paulo Medical School, and/or the Hospital Israelita Albert Einstein, São Paulo, Brazil.

Disclosure: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

For additional information, please contact: Ms. Jo Ann M. Eliason, Communications Manager, Journal of Neurosurgery Publishing Group, One Morton Drive, Suite 200, Charlottesville, VA 22903. Email:; Phone: 434-982-1209.

For 74 years, the Journal of Neurosurgery has been recognized by neurosurgeons and other medical specialists the world over for its authoritative clinical articles, cutting-edge laboratory research papers, renowned case reports, expert technical notes, and more. Each article is rigorously peer reviewed. The Journal of Neurosurgery is published monthly by the JNS Publishing Group, the scholarly journal division of the American Association of Neurological Surgeons. Other peer-reviewed journals published by the JNS Publishing Group each month include Neurosurgical Focus, the Journal of Neurosurgery: Spine, and the Journal of Neurosurgery: Pediatrics. All four journals can be accessed at

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 10,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the brain, spinal column, spinal cord, and peripheral nerves. For more information, visit

Journal of Neurosurgery Publishing Group

Related Neurosurgery Articles:

When Hollywood met neurosurgery
A team of computer engineers and neurosurgeons, with an assist from Hollywood special effects experts, reports successful early tests of a novel, lifelike 3-D simulator designed to teach surgeons to perform a delicate, minimally invasive brain operation.
AOSpine North America provides a glimpse into the future of spine care
AOSpine North America has brought together experts to provide a glimpse into the next generation of spine care leading to a supplement in Neurosurgery on the 'Future Advances in Spine Surgery.'
Cedars-Sinai investigators identify human brain processes critical to short-term memory
Cedars-Sinai neuroscientists have uncovered processes involved in how the human brain creates and maintains short-term memories.
New study in Neurosurgery finds overlapping surgery is safe and efficient
Overlapping surgery occurs when a surgeon oversees two operations at the same time.
Sanford neurosurgeon's pediatric stroke case published in national journal
A 9-day-old baby who suffered a normally fatal stroke was saved after a Sanford Health cerebrovascular neurosurgeon removed the clot by combining mechanical and medicinal therapies.
Mount Sinai establishes 3-D printing services for clinicians and researchers
3-D printing team will cater to unique modeling requests with quick turnaround times and costs far below market levels.
Oxford University Press Partners with the Congress of Neurological Surgeons
Oxford University Press (OUP) is pleased to announce its new partnership with the Congress of Neurological Surgeons (CNS).
Risk factors for unplanned hospital readmission following pediatric neurosurgery
Researchers at the University of Alabama at Birmingham have determined specific risk factors associated with hospital readmission following pediatric neurosurgery.
More than 10 risk factors identified in readmission of pediatric neurosurgery patients
Big data provides insight into patient readmission after pediatric neurosurgery.
'Wrong' scale used to evaluate results of brain surgery
The most common scale used to evaluate outcome of neurosurgical procedures, the modified rankin scale (mRS) -- does not measure what is commonly assumed, concludes a study conducted at the Department of Neurosurgery of Helsinki University Hospital.

Related Neurosurgery Reading:

Handbook of Neurosurgery
by Mark S. Greenberg (Author)

...the reason this new edition is particularly unique and appealing, is the incredible reorganization. Each section is consciously split-up to be both more comprehensive and more concise. A concerted effort has been made to have each section organized into parallel subsections for ease of reading throughout....Overall, Handbook of Neurosurgery is one of the most important texts in neurosurgery. -- World Neurosurgery

There are, of course, many books on neurosurgery available, but to this reviewer, Dr. Greenberg's newest edition is highly useful and the... View Details

Tarascon Neurosurgery Pocketbook
by MG Hayden Gephart (Author)

The Tarascon Neurosurgery Pocketbook brings neurologists, neurosurgeons and residents the most convenient and comprehensive pocket reference available today. This concise, organized pocket guide is packed with essential lists, figures, & tables providing instant reminders of hard-to-remember, vital clinical information. This pocket reference guide covers an array of neurosurgery topics including brain tumors. No other Neurologic reference of this kind incorporates neurosurgery, neurology and neuro-critical care in one reference. The Tarascon Neurosurgery Pocketbook is an unmatched resource... View Details

When the Air Hits Your Brain: Tales from Neurosurgery
by Frank T. Vertosick Jr. (Author)

The story of one man's evolution from naive and ambitious young intern to world-class neurosurgeon.

With poignant insight and humor, Frank Vertosick Jr., MD, describes some of the greatest challenges of his career, including a six-week-old infant with a tumor in her brain, a young man struck down in his prime by paraplegia, and a minister with a .22-caliber bullet lodged in his skull. Told through intimate portraits of Vertosick’s patients and unsparing yet fascinatingly detailed descriptions of surgical procedures, When the Air Hits Your Brain―the... View Details

Neurosurgery Explained: A Basic and Essential Introduction
by Willem Adriaan Liebenberg (Author)

Professor Al Rhoton says about this book: "This book meets and exceeds its goal of being "a resident's survival guide." The book will be especially helpful to trainees in neurosurgery, however, medical students, interns, and multiple other medical specialists will also find it useful. I found the contents interesting, enlightening, and beneficial even after decades of neurosurgical practice." This is what Profffessor Joanne Hickey says about the book: "well written, well organized, and practical text described by the author as a 'resident's survival guide'. It is a text that will be... View Details

Neurology pocketcard Set
by Ruediger Ilg (Author), Sebastian Stuckrad-barre (Author)

This pocketcard Set contains all the important information that neurologists need all day:

* Neurological examination
* Survey of dermatomes, cranial nerves, clinically relevant muscles, and cerebral vessels
* Mini-Mental State Test and Glasgow Coma Scale
* NEW: third card on cerebral vessels and territories, and nerves of the upper and lower extremities View Details

Essential Neurosurgery
by Andrew H. Kaye (Author)

Essential Neurosurgery provides a comprehensive introduction to neurosurgery for junior surgical trainees and medical students. The book concentrates on the principles of neurosurgical diagnosis and management of the more common central nervous system problems, including an understanding of neurology and the pathological basis of neurological disease. There is also coverage of neurosurgical techniques and postoperative patient management.

This new edition brings the text fully up to date and includes many of the biological and technological advances made in the field of... View Details

Do No Harm: Stories of Life, Death, and Brain Surgery
by Henry Marsh (Author)

Do No Harm Stories of Life Death and Brain Surgery View Details

100 Case Reviews in Neurosurgery, 1e
by Rahul Jandial MD PhD (Author), Michele R Aizenberg MD (Author), Mike Y. Chen MD PhD (Author)

Jandial’s 100 Case Reviews in Neurosurgery is the only reference offering a comprehensive approach to effective preparation for oral examinations, MOC, or grand rounds. Ideal for residents and graduates alike, it covers 100 of the most commonly encountered neurosurgical cases and presents them in a layout mirroring that of the oral exams. This singular resource eliminates the need to consult several texts, providing readers with all of the complete, concise knowledge needed to go in with confidence.

Expert Consult eBook version included with... View Details

Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals
by Michael Wang (Editor), Andrea Strayer (Editor), Odette Harris (Editor), Cathy Rosenberg (Editor), Praveen Mummaneni (Editor)

This practical handbook allows nurses, advanced practice nurses, physician assistants, and allied health professionals practicing in the fields of neurosurgery, neurology, and spinal care to quickly review essentials while in the work environment. It emphasizes procedural steps and critical elements in patient management, including intensive care, the neurological examination, differential diagnoses, and pain management. Written by a multidisciplinary team of experts, the handbook is expected to become a well-worn companion and essential aid to the busy practitioner.

View Details

Neurosurgery Knowledge Update: A Comprehensive Review
by Robert Harbaugh (Editor), Christopher I. Shaffrey (Editor), William T. Couldwell (Editor), Mitchel S. Berger (Editor)

 Praise for this book:

The book is quite engaging, is an easy read, and has details that can be immediately applied to your practice. For those who create lectures for residents, fellows, or CME courses, the key points in each chapter are worth integrating into the lecture material, and this is especially true if one intends to use an audience-response system in their presentation. -- American Journal of Neuroradiology

Certification from the American Board of Neurological Surgeons (ABNS) is the gold standard for certification of neurosurgeons... View Details

Best Science Podcasts 2018

We have hand picked the best science podcasts for 2018. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

The Consequences Of Racism
What does it mean to be judged before you walk through the door? What are the consequences? This week, TED speakers delve into the ways racism impacts our lives, from education, to health, to safety. Guests include poet and writer Clint Smith, writer and activist Miriam Zoila Pérez, educator Dena Simmons, and former prosecutor Adam Foss.
Now Playing: Science for the People

#465 How The Nose Knows
We've all got a nose but how does it work? Why do we like some smells and not others, and why can we all agree that some smells are good and some smells are bad, while others are dependant on personal or cultural preferences? We speak with Asifa Majid, Professor of Language, Communication and Cultural Cognition at Radboud University, about the intersection of culture, language, and smell. And we level up on our olfactory neuroscience with University of Pennsylvania Professor Jay Gottfried.