Intraoperative technology in skull base and vascular neurosurgery: a two-stage cross-sectional national survey

Skull base and vascular neurosurgery rely on diverse intraoperative technologies, but contemporary data describing how frequently they are used at the level of individual operations are limited. On behalf of the Society of British Neurological Surgeons (SBNS) MedTech Committee, we aimed to establish a dated descriptive baseline of reported technology use across three operative paradigms. We conducted a two-stage cross-sectional survey of neurosurgeons in the UK and Ireland via the Society of British Neurological Surgeons (SBNS). Six MedTech Committee members compiled a pragmatic technology list. Respondents reported frequency of use for three exemplar procedures: transsphenoidal pituitary adenoma, retrosigmoid vestibular schwannoma, and pterional aneurysm surgery. Use was recorded on a four-point ordinal scale and analysed descriptively, with Kendall’s tau-b used to explore the relationship between experience and reported use. Twenty-four responses from 20 of the 32 adult or mixed adult-paediatric UK units were analysed (11 units per index procedure). Reported use was strongly procedure specific. Neuronavigation was used always or almost always by 8/12 transsphenoidal respondents but infrequently elsewhere. Endoscopy had displaced microscopy in transsphenoidal surgery, whereas microscopy was used always or almost always by all retrosigmoid and pterional respondents. Indocyanine green and micro-Doppler were routine for aneurysms. Neurophysiological monitoring was universal for vestibular schwannoma but evenly divided for aneurysms. Exoscopes, intraoperative MRI and robotics were used infrequently or not at all; augmented reality was reported by 5/13 pterional respondents. No association was found between experience and reported use, though this was underpowered. Reported intraoperative technology use is strongly shaped by operative paradigm, with established technologies clustering around recurring procedural needs. Newer technologies were used infrequently. Because availability was not recorded, non-use cannot be distinguished from lack of access. These data provide a dated baseline against which future change can be assessed.