Key Points

• Advances in optical technology and in neu-roimaging have resulted in the establishment of neuroendoscopy - a minimally invasive technique.

• There is a dearth of Class I evidence of the benefits and risks of this technique.

• Neuroendoscopic third ventriculostomy is currently the primary treatment of choice for selected cases of non-tumorous and tumorous hydrocephalus.

• The only demonstrable benefit on present evidence is freedom of complications from implanted devices.

• There are particular applications in the management of shunt complications, intraventricular and paraventricular tumors, and non-tumorous cysts.

• Proper training is essential and the technique should probably remain within the hands of a restricted number of specialists.

• Unstructured propagation is likely to be associated with avoidable morbidity.

• Regulatory authorities should monitor morbidity until the position is clear.

• Prospective studies are required to evaluate the hazards as well as the benefits in comparison with older approaches.

• The future may bring more sophisticated applications in conjunction with image guidance.

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