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A minimally invasive procedure used in brain surgery for the removal of tumors is neuroendoscopy. With no or few scars, a neuroendoscopic camera is adequately guided to our brain. The doctor assesses the condition that has to be treated once the camera has reached the brain. Compared to that of conventional brain surgery, this process leaves fewer scars, causes less harm to normal tissues, and has a lower chance of consequences. The size of the global market for neuroendoscopy devices was around $186.99 million in 2021 & is anticipated to grow to $314.31 million by 2030, reflecting a CAGR of 5.94% from 2021 to 2030.

Numerous illnesses inside the ventricular system, including intra & paraventricular tumours and cysts and obstructive hydrocephalus can be treated using transventricular neuroendoscopic techniques. Large skull base lesions are being removed via skull base transnasal transsphenoidal endoscopy (craniopharyngiomas, pituitary adenomas, meningiomas, and clival chordomas). Almost all types of neurosurgical procedures, including aneurysm and tumour surgery, can benefit from the use of an endoscope to aid micro neurosurgery. 

Treatment of the hydrocephalus

The widely used standard therapy for obstructive hydrocephalus is ETV. It has a success percentage of greater than 60% and is used as the first line of treatment for aqueductal stenosis. Treatment for hydrocephalus brought on by tectal plate lesions using ETV is similarly successful. The cause of the hydrocephalus and the patient’s age has an impact on the outcomes of ETV in patients. Young children with congenital hydrocephalus or those paired with myelomeningocele do not respond well to treatment, whereas older children, along with adolescents (>70%), have higher success rates.

Treatment of intraventricular tumors and cysts

A tumor biopsy, tumor removal, cyst fenestration, and metastatic disease evaluation are all endoscopic procedures. Quadrigeminal arachnoid cysts or Hydrocephalic suprasellar make suitable candidates for endoscopic fenestration. The majority of patients who have intraventricular cysts or tumors also have hydrocephalus. Due to the ability to handle tumors and divert CSF simultaneously, endoscopic surgery is especially helpful in this situation.

Treatment of the HH

The inferior hypothalamus is the site of HHs, which are uncommon non-neoplastic congenital abnormalities linked to cognitive issues, early puberty, and gelastic seizures. All patients, with the exception of those who have premature puberty, need surgery. For big HHs, the transcallosal craniotomy method is preferred. For minor lesions, gamma-knife surgery is surely a possibility. Small- to medium-sized HHs have successfully undergone stereotactic radiofrequency thermocoagulation with positive short-term outcomes.

Surgery for the craniosynostosis disease

In the early days of MI surgery, Jimenez and colleagues treated craniosynostosis. Before the age of six months, EACS or endoscopy-assisted craniosynostosis surgery can be used to treat this issue, along with postoperative helmet shaping therapy. Three months old is the ideal age for EACS. With a conventional arsenal and an endoscope equipped with a working shaft for usage with the endoscopic facelift surgery without irrigation, the procedure—basically a strip craniectomy—can be carried out. Low complication rates and a high success rate were both reported by the authors. For blood aspiration, a different aspirator is utilized in tandem with the endoscope.

CONCLUSION

Neuroendoscopic surgery is expected to have a promising future. The area will gain from additional advancements in camera and optical technology miniaturization, improvements in surgical instrument design, new navigation or robotics systems, multiport endoscopic surgery, and improved endoscope-assisted microsurgeries along with bimanual microdissection capabilities. Endoscopic surgery will be extended beyond skull base and intraventricular lesions to the intra-parenchymal brain lesions thanks to the continued development of endoscopic tools and cutting-edge surgical procedures, such as multiport approaches. Endoscope-assisted microsurgery’s future depends on these developments. 

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