{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T12:14:53Z","timestamp":1788437693120,"version":"build-2803163510"},"reference-count":17,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sci.","Brain Sciences"],"abstract":"<jats:p>Background: Neuroendoscopy complements exoscopic visualization by providing angled views of anatomical structures hidden from the direct surgical line of sight. However, its practical indications and intraoperative contribution during exoscope-assisted skull base surgery have not been systematically evaluated. This study aimed to characterize the patterns of neuroendoscopic use and its observed intraoperative contribution during exoscope-assisted skull base surgery. Methods: We retrospectively reviewed 164 consecutive skull base procedures performed between March 2024 and June 2026. After excluding 58 pure endoscopic endonasal procedures, 106 exoscope-assisted procedures were analyzed. Neuroendoscopic assistance was used in 42 procedures, each performed in a different patient. Complete operative video recordings from these 42 procedures were retrospectively reviewed by two neurosurgeons, and the observed contribution of neuroendoscopy was classified as visualization-only, confirmatory, or decision-changing. Results: Neuroendoscopic assistance was used in 42 of 106 exoscope-assisted procedures (39.6%), including 30 aneurysms and 12 tumors. The most common indication was clip and perforator confirmation during aneurysm surgery (30\/42, 71.4%). The observed contribution was classified as visualization-only in 8 procedures (19.0%), confirmatory in 20 (47.6%), and decision-changing in 14 (33.3%). Among the 14 decision-changing procedures, neuroendoscopic findings led to clip repositioning in 5 aneurysm procedures and additional tumor removal in 9 tumor procedures. No complications judged attributable to neuroendoscope insertion or manipulation were identified in the 42 procedures. Conclusions: Neuroendoscopic assistance provided additional intraoperative information during exoscope-assisted skull base surgery, with decision-changing findings identified in 14 of 42 assisted procedures. These findings characterize the observed contribution and practical indications of neuroendoscopic assistance; however, the retrospective design, selective use of neuroendoscopy, and limited sample size preclude conclusions regarding comparative efficacy or safety.<\/jats:p>","DOI":"10.3390\/brainsci16090942","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:08:53Z","timestamp":1788433733000},"page":"942","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Practical Indications and Intraoperative Contribution of Neuroendoscopic Assistance During Exoscopic Skull Base Surgery: A Single-Center Experience"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0760-5024","authenticated-orcid":false,"given":"Fumihiro","family":"Matano","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Miku","family":"Tsuruya","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Satsuki","family":"Imaoka","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5985-4447","authenticated-orcid":false,"given":"Kaoru","family":"Namatame","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3906-3719","authenticated-orcid":false,"given":"Megumi","family":"Tomita","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, 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Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Kazutaka","family":"Shirokane","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Katsuya","family":"Umeoka","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, 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A Systematic Review of the Technical, Surgical, and Educational Aspects","volume":"124","author":"Ricciardi","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"289","DOI":"10.3340\/jkns.2017.0202.003","article-title":"From Exoscope into the Next Generation","volume":"60","author":"Nishiyama","year":"2017","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Murai, Y., Shirokane, K., Sato, S., Higuchi, T., Kubota, A., Ozeki, T., Matano, F., Sasakai, K., Yamaguchi, F., and Morita, A. (2022). Preliminary Clinical Surgical Experience with Temporary Simultaneous Use of an Endoscope during Exoscopic Neurosurgery: An Observational Study. J. Clin. 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