Abstract

Classic craniotomy for biopsy or resection of intra-axial brain tumors usually employed large skin flaps and craniotomy openings. These were necessary so that surgeons could be certain that a subcortical tumor could be localized and that the extent of the lesion lay somewhere beneath and within the limits of the craniotomy. Localization methods for classic resection methods were qualitative and imprecise.

Abstract

Currently, one of the most exciting areas of growth in neurosurgery involves neuroendoscopy. As in the fields of general, gynecologic, orthopaedic, thoracic, and urologic surgery, neurosurgeons are exploring the utility of the endoscope and its changing technology. The use of endoscopes in neurosurgery is actually not new. In 1920 Mixter first reported using one to treat a hydrocephalic child. The early scopes suffered from poor illumination and the need for the surgeon to look directly through the scope, using it in a manner similar to a telescope. In the 1950s this changed with significant advances in endoscopic optics. Harold Hopkins, a professor of applied optical physics, improved the conventional solid glass rod lens system with a resulting improvement in the scope’s image. He also developed “coherent” fiber bundle technology which made the flexible endoscope possible. These advances, coupled with better diagnostic testing (CT and MR scanning) and the miniaturization of video cameras, have resulted in the current explosion of interest in neuroendoscopy.