neuroendoscopic

Neuroendoscopy refers to surgical procedures that use an endoscope to access the ventricular system and surrounding intracranial spaces for diagnosis and treatment. Neuroendoscopic techniques provide visualization, illumination, and working channels that enable minimally invasive management of hydrocephalus, colloid cysts, intraventricular tumors, arachnoid cysts, and related conditions.

History of neuroendoscopy began to accelerate in the late 20th century as rigid and flexible endoscopes, irrigation systems, and imaging improved. Endoscopic third ventriculostomy (ETV) emerged as a prominent treatment for obstructive hydrocephalus, helping establish broader use of intraventricular endoscopy. Since then, techniques have expanded to cyst fenestration, biopsy, and limited tumor management, with ongoing refinements in instrumentation and imaging.

Indications include obstructive hydrocephalus due to aqueductal stenosis or lesions, colloid cysts of the third ventricle, fenestration of arachnoid cysts, and evacuation or biopsy of intraventricular tumors and hematomas. Neuroendoscopy is used as a minimally invasive alternative when conventional microsurgery would require greater brain exposure or retraction, and it is complemented by other endoscopic approaches in selected cases.

Techniques rely on burr-hole access, a neuroendoscope with a working channel, constant irrigation, and suction. Instruments such as graspers, scissors, biopsy forceps, and suction catheters are used through the endoscope. Modern practice often incorporates neuronavigation, intraoperative imaging, and both rigid and flexible endoscopes to navigate complex ventricular anatomy.

Risks include injury to neural structures (such as the fornix), vascular injury, bleeding, infection, and cerebrospinal fluid leaks. Outcomes vary by indication and patient factors, but neuroendoscopic approaches can reduce tissue disruption and shorten recovery relative to open surgery. Training typically requires specialized neurosurgical experience and mentored hands-on experience.