Endoscopic Minimally Invasive Neurosurgery: Emerging Techniques and Expanding Role through an Extensive Review of the Literature and Our Own Experience – Part II: Extraendoscopic Neurosurgery

Abstract

Background/Aims: The field of minimally invasive neurosurgery has grown dramatically especially in the last decades. This has been possible, in the most part, due to the advancements in technology especially in tools such as the endoscope. The contemporary classification scheme for endoscopic procedures needs to advance as well. Methods: The present classification scheme for neuroendoscopic procedures has become confusing because it mainly describes the use of the endoscope as an assisting device to the microscope. The authors propose an update to the current classification that reflects the independence of the endoscope as a tool in minimally invasive neurosurgery. Results: The proposed classification groups the procedures as ‘intraendoscopic’ neurosurgery or ‘extraendoscopic’ neurosurgery (XEN) in relation to the ‘axis’ of the endoscope. A review of the literature for the XEN group together with exemplary cases is presented. Conclusion: We presented our proposed classification for the endoscope-only surgical procedures. The XEN group is expanded in this article.

The endoscope and instruments for minimally invasive neurosurgery

“…A contemporary classification has been proposed in the last few years for endoscopy in minimally invasive cranial neurosurgery taking into consideration its vast application and potential. The procedures can now be grouped as "intraendoscopic" or "extraendoscopic" based on the relation of surgical exercise with the axis of the endoscope [88] . This expands the scope of MIS beyond the traditionally defined realms.…”

The history of neurosurgery and its relation to the development and refinement of the frontotemporal craniotomy

“…Multiple studies have demonstrated the benefits of their use as an adjunct to or a replacement for the operative microscope, depending on the procedure. 2,3,23,24,46 Recent studies have developed an ever-expanding list of pathologies accessible endoscopically, especially through the endonasal corridor. 37,56,65 As these approaches mature, endoscopy will become a more commonly used technology to aid the neurosurgeon in the operating room, just as the microscope did a generation ago.…”

Vestibular Schwannoma Surgical Treatment

“…The endoscopic technique is an established component of contemporary brain tumor surgery approaches and is widely used in various skull base surgeries, especially pituitary adenomas . This technique allows direct viewing under high magnification and visualization under angle and is minimally invasive and team surgery .…”