Instrumentation [3

Modern neuroendoscopic techniques are enabled by, and are dependent upon, purpose-built neuroendoscopes utilizing high-quality optical systems and dedicated instrumentation. Although there are a number of neuroendoscopes available, there are three basic patterns: rigid, flexible and, more recently, the disposable Channel™ neuroendoscopes. The comparative features are detailed in Table 6.2. Individual surgeons will inevitably have their own preferences based upon the usual range of experiences, prejudices, purchasing opportunities and persuasiveness of sales people. However, it is important in selecting neuroendoscopes to consider the use to which they will be put. The most commonly performed intraventricular procedure will always be third ventriculostomy; for some surgeons that may be the only neu-roendoscopic operation that they adopt. The superior visibility, ease of use, and simplicity of orientation make a rigid endoscope or the Channel™ neuroendoscope the most frequently employed devices. Although flexible neuroendoscopes are relatively unpopular, they come into their own when procedures are to be performed at two anatomically distinct sites, such as tumor biopsy coupled with third ventricu-lostomy. Similarly, if there are unusual anatomical conditions such as those encountered in patients with hydrocephalus associated with the dysraphic states or particularly narrow inter-ventricular foramina, then a flexible neuroendoscope may be the only safe and practical choice. This is particularly the case in pediatric practice.

For tumor biopsy, the size of the specimen is important so as to give the neuropathologist the maximum material for diagnosis and to minimize the effects of crush artifact; the

Table 6.1. Comparison of surgical treatments for hydrocephalus [2]
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