History

The first endoscopic neurosurgical procedure was performed by Lespinasse in 1910. Although not a neurosurgeon but a urologist, he successfully performed endoscopy via burr holes with choroid plexus coagulation in two children with hydrocephalus. He never published this procedure, although he reported on it at a local surgical society meeting (1).

The first neurosurgeon to perform a third ventriculostomy was Mixter (2), who combined ventriculoscopy with that procedure in 1923 in an attempt to treat hydrocephalus. However, this procedure was abandoned mainly because of the lack of adequate diagnostic techniques and also because of technical issues related to the endoscopes.

Not until the development of better endoscopes, improved imaging techniques in neuroradiology, better understanding of neurophysiology, and knowledge of microsurgical anatomy did neuroendoscopy reestablish itself in neurosurgery.

From: Minimally Invasive Neurosurgery, edited by: M.R. Proctor and P.M. Black © Humana Press Inc., Totowa, NJ

The reintroduction of endoscopy in Neurosurgery occurred in the second half of the 20th century (3,4) and consisted of the use of flexible endoscopes as assistive devices in microsurgery, primarily to improve visualization and also to perform a biopsy of an intraventricular tumor.

Currently, endoscopy is performed for spinal disease (disc removal and exploration of the spinal subarachnoid spaces), for peripheral nerve surgery (carpal tunnel syndrome), for craniosynostosis (endoscope-assisted strip craniectomy), and in the treatment of a variety of intracranial disorders (e.g., hydrocephalus, cysts, intraventricular brain tumors, intraparenchymal hemorrhage, aneurysm clipping). This list of diseases and neurosurgical conditions treated by endoscopy will most certainly expand with the growing experience of neurosurgeons and with the refinement of the current endoscopic equipment for specific applications.

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