Table 6.2. Features of neuroendoscopes: rigid vs flexible vs disposable

Type of endoscope




Excellent optics Ease of use Good instrumentation Durable

Relatively inexpensive

Larger size

Restricted range of angulation


Manoeuverable Smaller size

Disorientation More difficult to use Poorer optics Poorer instrumentation Smaller biopsies Fragile

Relatively expensive

Channel™ (disposable)

Very easy to set up Good optics Relatively small caliber Excellent instrumentation Inexpensive

Convenient, safe single use

Restricted range of angulation

present author finds the generous caliber of biopsy forceps permitted by the Channel™ neuroendoscope to be superior.

The range and quality of adjunctive instrumentation continue to increase, and currently include monopolar and bipolar diathermy, biopsy and grasping forceps, scissors, dissecting hooks, aspirating needles, catheters and inflatable balloons. The laser has advocates, and the author has found the KTP laser (Laserscope UK) to be particularly appropriate to neuroendoscopy. More specialized viewing endoscopes have been developed for endo-scope-assisted ventricular shunt insertion and for endoscope-assisted microneurosurgery. A fine malleable endoscope is the most useful adjunct in aneurysm surgery and in some skullbase procedures. For transnasal endoscopic pituitary surgery, the endoscopes and allied instruments used in endoscopic sinus surgery are the most appropriate. An absolute requirement is a competent irrigation system in order to maintain good visibility. There is no evidence that special 'physiological' irrigating fluids are advantageous. The author's practice is to employ normal saline, irrigated under simple pulsed pressure that is operated by a footswitch and passed through a blood warmer.

A camera, a monitor and a fiberoptic light source are required. Ever since the first endo-scopic photographs of the living human cerebral ventricles were taken in Philadelphia in

1922, the value and attraction of a photographic record have been recognized. The ability to make good-quality videocassette recordings cannot be overstated. Not only are they useful for training and teaching purposes, but also they are of great value to the surgeon for self-education and improvement on the rather steep learning curve involved. Recordable DVDs are replacing videocassettes.

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