Background: Innovation is a part of the daily practice of neurosurgery. A clear definition of what constitutes innovation is currently lacking, however, and opinions vary from continent to continent, from hospital to hospital, and from surgeon to surgeon. Methods: In this study, we distributed an online survey to neurosurgeons from multiple countries to investigate what neurosurgeons consider innovative, by gathering opinions on several hypothetical cases. The anonymous survey consisted of a total of 52 questions and took approximately 10 minutes to complete. Results: A total of 355 neurosurgeons across all continents excluding Antarctica completed the survey. Neurosurgeons achieved consensus (>75%) in considering specific cases to be innovative, including laser resection of meningioma, focused ultrasound for tumor, oncolytic virus, DBS for addiction, and photodynamic therapy for tumor. Although the new dura substitute case was not considered innovative, there was consensus among neurosurgeons indicating that IRB approval was still necessary to maintain ethical standards. Furthermore, although 90% of neurosurgeons considered an oncolytic virus for GBM to be innovative, only 78% believed that IRB approval was necessary prior to 68 treatment. Conclusions: Our results indicate that innovation is a heterogeneous concept among neurosurgeons that necessitates standardization to ensure appropriate patient safety without stifling progress. We discuss the ethical drawbacks of not having a clear definition of innovation, the current challenges in achieving a unifid understanding of innovation in neurosurgery, and offer suggestions for uniting the field going forward.

Introduction

Innovation is at the heart of neurosurgery. In a continually evolving field, neurosurgeons must constantly assess and reassess the most appropriate and effective treatments for each patient. Innovation is conducted by neurosurgeons investigating novel treatments for brain tumors in major academic institutions, as well as those performing creative surgeries in low resource settings across the world.1, 2 Yet, something so ubiquitous among neurosurgeons remains difficult to define with consensus. To this day, great heterogeneity exists in what surgeons consider innovative 3, 4 . Various interpretations of what constitutes innovation leads to a lack of standardization of assessing innovation across surgeons, departments, institutions, and nations. Additionally, proof of the innovative nature of a project is often a key component of securing grant funding; therefore, efforts to standardize what should be considered innovative could be beneficial to funding agencies.