Introduction: A clear definition of what constitutes innovation in neurosurgery is currently lacking. The aim of this study was to investigate what neurosurgeons consider to be innovative by gathering the opinions of neurosurgeons on several hypothetical cases.
Methods: An anonymous survey of 52 questions containing 11 hypothetical cases was sent to members of the Ethics Committee of the World Federation of Neurosurgical Societies (WFNS) and all individual members of the European Association of Neurosurgical Societies (EANS). For each case, respondents were asked to select their opinion via Likert scale on the following statements: 1) This case is an example of innovation in neurosurgery; 2) By not having obtained some sort of approval from the IRB or an innovation committee for this case, the neurosurgeon violated ethical standard in this case; 3) Advancing the field of neurosurgery was valued more than individual patient care. Lastly, respondents were asked what type of innovation they considered each case: none, minor modification of a standard procedure, major modification of a standard procedure, or a radical innovation. Responses were collected from November 21, 2016 to December 30, 2016.
Results: A total of 356 neurosurgeons responded. Overall, there is great heterogeneity among what neurosurgeons consider innovative and what constitutes ethical misconduct. Neurosurgeons considered certain cases more innovative (=75% considered innovative), such as using an adenovirus for glioblastoma mulitiforme or deep brain stimulation for addiction. Other cases were considered less innovative (=25% considered innovative), such as a new dura substitute.
Conclusions: Neurosurgeons lack a clear definition of innovation. This lack of consensus poses practical and ethical concerns relevant to appropriate oversight of innovative procedures. In the future, appropriate steps should be taken to define innovation in neurosurgery so that neurosurgeons can use innovation to advance the field of neurosurgery without compromising patient safety.
Patient Care: This research will open dialogue among neurosurgeons about what constitutes appropriate oversight in neurosurgical innovation in order to ensure ethical and safe patient care.
Learning Objectives: 1) To appreciate the lack of consensus in defining innovation in neurosurgery.
2) To understand various perspectives on what constitutes surgical innovation.
3) To understand the practical and ethical consequences of not having a standardized definition of innovation in neurosurgery.