Innovation in neurosurgery: Evaluation of neurosurgical innovation, related ethics, and solutions

Patient outcomes have been tremendously improved through neurosurgical innovation for which there are countless examples. However, how neurosurgical innovation occurs generally lacks structure. This lack results in several ethical and practical problems related to patient safety. In this thesis, a new framework for neurosurgical innovation is proposed. This framework aims to provide an adequate valuation of structured and careful innovation. In recent neurosurgical innovations, related ethical dillema’s and excisiting frameworks for innovation were evaluated to come to this framework.Based on an extensive review of the literature, several recent neurosurgical innovations were not introduced in a structured fashion. This unstructured introduction holds potentially far-reaching consequences for informed consent, patient safety, and knowledge regarding long-term outcomes.Neurosurgical innovation holds several ethical dilemmas. These dilemmas range from the need to innovate in an emergency setting to the learning curve that every novel procedure brings. This thesis describes these dilemmas in detail and discusses potential solutions.Existing frameworks for innovation in medicine, such as the IDEAL Framework and learning health systems, have limited application to neurosurgery because of its unique patient population. Nevertheless, these frameworks form the inspiration for the beforementioned newly suggested framework for neurosurgical innovation.