**1. Introduction**

Neuroendoscopy treats the pathologies of the central nervous system applying an endoscope. With the ever improving methods to treat cranial pathologies neuroendoscopy is being applied more and more to treat different pathologies. In this chapter, we will discuss the brief history, clinical application and important neuroendoscopic approaches along with the advantages, disadvantages, complications or important considerations in the procedures.

In **Table 1**, the events those revolutionized the endoscopic neurosurgery, are summarized.

In the early 1970s, both flexible fibreoptic and high-resolution rigid endoscopes could be developed based on the technological advances in optics and electronics. Those were used successfully for operating within the ventricles. From that point of treating hydrocephalus, the neuroendoscopy has progressed to endoscope-assisted surgical procedures which began in the 1980s and 1990s. This minimally invasive procedure retained its popularity and continued till now [6].

At the initial days of neuroendoscopy, as ventricles contain the ideal medium of crystal-clear CSF, the endoscopic procedures were confined to those. Currently, the field of neuroendoscopy has extended beyond ventricular procedures and is currently applied for all types of neurosurgically treatable diseases such as intracranial cysts, intraventricular tumors, hypothalamic hamartoma (HH), skull base tumors, craniosynostosis, degenerative spine disease, and rare subtypes of hydrocephalus [7].


**Table 1.**

*Revolutionary events in endoscopic neurosurgery.*

The benefit in minimally invasive endoscopic procedures is analogous to that of any endoscopic procedure and can be listed as follows:


In neurosurgery, to minimize operative trauma, the surgeon tries hard to limit the size of the exposure and to avoid unnecessary brain retraction, which can cause damage by increasing pressure to the surrounding normal brain tissue and minimizing the regional cerebral blood flow [8] which has short-term and long-term knock on effect and these eventually may compromise the neurologic outcome following microneurosurgical procedures. The outcome can potentially be improved by the use of neuroendoscopy techniques. The endoscope enhances the surgeon's view by increasing illumination and magnification [9, 10], which makes it an excellent teaching tool. A comparison of endoscope and microscope from a survey of the neurosurgeons shows that microscope is superior only for less fatigue of the hand and 3D vision which are now removed with endoscope holder and 3D view of endoscopes. This 3D view is clearly more advantageous in looking at the areas, that were difficult to visualize with microscope. With the advent of different angled endoscopes, e.g. 30°, 45°, 70°, 110°, it is possible to have a panoramic view of the field [6].
