Recent developments in neuroimaging have caused a renewed interest in endoscopic neurosurgery. Pathology in endoscopic neurosurgery suitable for endoscopic approach should be situated in the paraor intraventricular region, or should be a solitary cyst. C.T. and M.R.I. scans provide excellent visualization
of these anomalies enabling a precise approach and planning strategy. In some cases, endoscopic treatment in neurosurgery is optional but in other cases it is highly advantageous over conventional and even blind stereotactic techniques. The endoscopic neurosurgery operations can be performed through one single burr hole. In many cases the patient is allowed to leave the hospital the day after surgery.

Only recently suitable and specially for endoscopic neurosurgery designed cerebral instrumentation has been developed. In 1986 Jacques Caemaert, from the department of neurosurgery of the University Hospital of Gent, Belgium, designed the first prototype of a new multipurpose neuroendoscope.

The requirements for this instrument were:

• a maximum outer diameter of 6 mm
• round in cross section to permit rotation around its own axis
• a long rigid sheath suitable for free-hand introduction with any stereotactic frame
• simultaneous visual control and operating possibilities
• continuous irrigation via separate inlet and outlet channels which are themselves wide enough to take small auxiliary operating instruments

For the endoscopic neurosurgery Richard Wolf company developed special instruments for endoscopic neurosurgery which fulfill present and future requirements of the neuro surgeon. After a long series of trial operations and 5 different prototypes, the final neuroendoscope was created. The last two developments were the use of a small flexible endoscope able to pass through the working channel and the possibility of using different rigid telescopes with various viewing angles. These rigid telescopes can now be advanced in a second stage beyond the tip of the sheath to penetrate small openings or channels and to "look around the corner". Today’s challenge is to gain experience in endoscopic neurosurgery and increase surgical skills. Clinical trials should continuously support the development of new instruments that can be used through the endoscope.

Indications

• intra- and paraventricular cysts
• arachnoid cysts
• ependymal cysts
• colloid cysts
• epidermoid cysts

Hydrocephalus

• third ventriculostomy
• aqueduct obstruction
• choroid plexus coagulation
• septum pellucidum fenestration
• shunts placement or correction

Tumour

• biopsy
• removal
• cystic tumours