Endoscopy has revolutionized neurosurgical treatment modalities in many ways. Today, many cases of hydrocephalus, cystic lesions, and other intraventricular pathologies are approached endoscopically.

Requirements for modern endoscopes suitable for Neurosurgery are brilliant visualization and illumination, high-quality equipment for intricate surgical manipulations, small outer diameter of the endoscope, and an ergonomic and convenient way of handling the endoscope and the instruments in order to compete with minimally in vasive micro - neurosurgery.

The ''Pediatric Endoscope system'' is highly adaptable and therefore suitable for a variety of surgical manipulations. In addition to its extraordinary small outer diameter and the convenient working length, it consists also of a simple but secure and reliable fixation device and a sophisticated insert for steering instruments around the corner. These characteristics make the Pediatric Endoscope system especially valuable for intraventricular endoscopic procedures in newborn and children, as well as in adults.

• small diameter - 4.4 x 3.3 mm or 6.1 x 4.8 mm
• telescopes with direction of view 5°, 30° or 70°
• different sheaths and working elements
• insert for steering instruments around the corner
• fixation device
• variety of auxiliary instruments

The most frequently performed endosopic procedure is ''endoscopic third ventriculostomy'' in patients with occlusive hydrocephalus. Here, a communication between the third ventricle and the prepontine cisterne through the floor of the third ventricle re-establishes physiological CSF pressure dynamics and enables a shunt-free life for the patient (figure). An additional indication for endoscopic surgery is asymmetric hydrocephalus, caused by unilateral obstruction of the foramen of Monro. A fenestration of the septum pellucidum, the so-called "endoscopic pellucidotomy" restores a communication between both lateral ven tri cles and avoids shunting or, in case of impared CSF reabsorbtion, avoids a second shunt system. Furthermore, "endoscopic shunt placement" and endoscopic removal of adherent intracranial shunt catheters facilitates shunting procedures to a great degree and improves long-term function of the shunt system.

Indications for endoscopic surgery in intracranial cystic lesions include colloid cysts, chorioid plexus cysts, and arachnoid cysts. The surgical goal is the removal or broad fenestration of the cyst wall. In the majority of arachnoid cysts, the cyst wall is adherent to the surrounding structures and has a tough consistency. Therefore, "endoscopic cyst fenestration" is the prefered method in order to create a wide communication between the cyst and the CSF-bearing spaces. Especially in suprasellar arachnoid cyst, endoscopic fenestration is the preferred treatment (figure).