neuroendoscopy

Neuroendoscopy is a neurosurgical technique that uses an endoscope to visualize and treat structures within the intracranial or spinal compartments. Endoscopes, which may be rigid or flexible, are inserted through natural openings or small surgical corridors and provide a working channel for instruments, enabling both diagnostic assessment and targeted therapy while reducing brain retraction in many cases.

Modern neuroendoscopy began in the late 20th century with improvements in endoscope optics, visualization, video systems, suction irrigation, and neuronavigation. This led to expanded applications in intraventricular procedures, skull base surgery, and, more recently, spinal endoscopy, with increasing emphasis on safety and minimally invasive approaches.

Common techniques include endoscopic third ventriculostomy for obstructive hydrocephalus; intraventricular biopsy and tumor sampling; fenestration of arachnoid or cystic lesions; and choroid plexus cauterization in selected infants. Skull base work is often performed via transnasal endoscopic routes to access pituitary and parasellar lesions or repair CSF leaks. Spinal procedures using endoscopy are less widespread but include intradural and intrathecal approaches in specialized centers.

Advantages of neuroendoscopy include reduced tissue disruption, shorter recovery, and improved visualization in narrow corridors. Limitations include restricted instrument maneuverability, a steep learning curve, and a limited working channel that may not allow complete resection. Risks are similar to other endoscopic procedures and include hemorrhage, infection, CSF leakage, and injury to neural structures. Careful patient selection, planning, and a skilled multidisciplinary team are essential.

Outcomes vary by indication and surgeon experience but many endoscopic procedures achieve symptomatic relief and hydrocephalus control with favorable morbidity profiles when appropriately applied.