The endoscope and instruments for minimally invasive neurosurgery

Abstract

The advent of neuroendoscopy catalyzed the ongoing development of minimally invasive neurosurgery in the 1990s. This millennium has seen rapid developments in the design of scopes, improved high-definition visualization systems, and a plethora of dedicated instruments. Many minimally invasive and endoscopic procedures have become the new “standard of care” today. Endoscopic third ventriculostomy and endonasal pituitary surgeries have replaced alternative techniques in most major institutes in the world and the indications are rapidly increasing to tackle many midline skullbase, intraventricular, and some parenchymal lesions as well. The scope of minimally invasive neurosurgery has extended to spine surgery, peripheral nerve surgery, and unique indications, viz. craniosynostosis repair. This review describes many of these developments over the years, evaluates current scenario, and tries to give a glimpse of the “not so distant” future.

Fully endoscopic posterior fossa decompression for Chiari malformation type I: illustrative case

“…[15][16][17] Endoscopic neurosurgery supports the concept of minimally invasive neurosurgery, whose main principle is to use as minimally invasive an approach as possible while maintaining sufficient surgical effect. [18][19][20] The case we have described shows that surgery for CM-I can be performed as a fully endoscopic microsurgical procedure. Based on the clinical anatomical study by Dolas et al, 14 a similar operation was performed.…”

Manual Instruments as an Alternative to Drilling for Bony Exposure in Skull Base Surgery: Concept and Technique

“…Manual instruments were routinely used for transsphenoidal surgeries; however, recently high-speed drills are used more in cases where standard pituitary chisel and hammer, Kerrison punches, and curettes were being used initially and usually are sufficient except for extended transsphenoidal approaches. 21,45,46 The authors do understand that high-speed drills are an important equipment for neurosurgery and reduce operative times; however, most of the advanced microneurosurgical procedures can be safely done with the help of manual instruments. 6 There are bone works required in few surgeries such as extended transsphenoidal surgeries, translabyrinthine approaches, and Kawase's approach where the role of drill is important.…”

Rotitome-G: Principles and design concept of experimental compliant continuum robotic microsurgical endoscopic sarcotome for pixel/voxel-level target access neurosurgery

“…At present several types of available individual mechanical instruments; laser and ultrasound-operated instruments for cutting; variable speed side cutting reciprocating aspirators with scissoring action; monopolar and bipolar cautery systems for haemostasis; abrasion of tumour tissues, retraction, flexible suction, etc. are either straight or angled at their working ends (Aylmore et al, 2022;Ebel et al, 2022;Shaikh & Deopujari, 2020). The greatest difficulty is to maneuvre them safely and triangulate within an unstructured and constrained space (Marcus et al, 2016).…”