Endoscopic Neurosurgery

An endoscope is a device that allows a surgeon to operate through a limited opening by providing remote visualization, illumination, and manipulation. The typical endoscope used in neurosurgery features a lens and camera for visualization, a light source for illumination, and one or more channels through which instruments can be directed for surgical manipulation. Most of the current applications of endoscopy in neurosurgery are directed at hydrocephalus.

While an endoscope can be helpful to the neurosurgeon in many ways, most neurosurgical procedures cannot be performed solely through an endoscope for a variety of reasons. The endoscope is most helpful when used to open a membrane, place a catheter at a precise location, or biopsy lesions associated with the brain’s fluid chambers (ventricles).

Endoscopic Cyst Fenestrations

Other thin membranes and cyst walls within or around the brain can be opened using the endoscope to relieve pressure caused by the blockage of CSF circulation. The technique is similar to an ETV but the hole is made to release an isolated (trapped) pocket of CSF into a ventricle or the subarachnoid space. Sometimes a small tube (stent) is left to keep the hole open after it is made.

Endoscope-Assisted Shunt Insertion

Endoscopes small enough to fit inside shunt tubes are sometimes used to achieve the best possible placement of the catheter tip within the patient’s ventricle. This technique can be applied to both new shunt insertion and the revision of shunts whose ventricular catheters are blocked.

Endoscopic Tumor Surgery

Brain tumors located within or adjacent to the lateral or third ventricles can often be reached with an endoscope. Only the smallest tumors can be removed through the endoscope and complete removal remains unlikely. A more reasonable goal in these situations is tumor biopsy. Many tumors that occur in these areas are either impossible to cure by any surgical treatment or can be cured with non-surgical means making complete removal unnecessary. As tumors in these locations frequently cause obstructive hydrocephalus, the biopsy can be combined with a simultaneous fenestration procedure.