Background/Aims: Minimally invasive neurosurgery is a growing field, more so in recent decades. The modernization of tools, especially the endoscope, has allowed for critical improvements and crucial advancements in minimally invasive neurosurgery. The current classification scheme for endoscopic procedures needs to be updated to reflect these advancements. Methods: Although the field of neuroendoscopy is continually evolving, the terminologies utilized to describe endoscopic procedures reflect and favor its use as mostly an assisting device complementing the microscope. Even though the classification was adequate for its time, it has become inexact and therefore confusing. We therefore propose a new classification scheme that encompasses the growing independence of endoscopic minimally invasive neurosurgery (EMIN) as well as the changing landscape within EMIN procedures. Results: We have classified our EMIN procedures, since 2002, as either ‘intraendoscopic’ (IEN) or ‘extraendoscopic’ (XEN) in relation to the endoscope’s axis. Exemplary cases of IEN and a review of the literature are presented as well. Conclusion: Our proposed classification scheme for solely endoscopic procedures is presented. The role of the endoscope as an independent tool is clarified.

1.
Fukushima T, Miyazaki S, Takusagawa Y, et al: Unilateral interhemispheric keyhole approach for anterior cerebral artery aneurysms. Acta Neurochir Suppl (Wien) 1991;53:42–47.
2.
Lan Q: Clinical application of keyhole techniques in minimally invasive neurosurgery. Chin Med J (Engl) 2006;119:1327–1330.
3.
Perneczky A, Fries G: Endoscope-assisted brain surgery. 1. Evolution, basic concept, and current technique. Neurosurgery 1998;42:219–224, discussion 224–225.
4.
Fries G, Perneczky A: Endoscope-assisted brain surgery. 2. Analysis of 380 procedures. Neurosurgery 1998;42:226–231, discussion 231–232.
5.
Jho HD: The expanding role of endoscopy in skull-base surgery: indications and instruments. Clin Neurosurg 2001;48:287–305.
6.
Prevedello DM, Doglietto F, Jane JA Jr, et al: History of endoscopic skull base surgery: its evolution and current reality. J Neurosurg 2007;107:206–213.
7.
Cappabianca P, Cinalli G, Cangemi M, et al: Application of neuroendoscopy to intraventricular lesions. Neurosurgery 2008;62(suppl 2):575–597, discussion 597–598.
8.
Jane JA Jr, Han J, Pervedello DM, et al: Perspectives on endoscopic transsphenoidal surgery. Neurosurg Focus 2005;19:E2.
9.
Li KW, Nelson C, Suk I, et al: Neuroendoscopy: past, present, and future. Neurosurg Focus 2005;19:E1.
10.
Cappabianca P, Decq P, Schroeder HW: Future of endoscopy in neurosurgery. Surg Neurol 2007;67:496–498.
11.
Kassam A, Carrau RL, Snyderman CH, et al: Evolution of reconstructive techniques following endoscopic expanded endonasal approaches. Neurosurg Focus 2005;19:E8.
12.
Hopf NJ, Perneczky A: Endoscopic neurosurgery and endoscope-assisted microneurosurgery for the treatment of intracranial cysts. Neurosurgery 1998;43:1330–1336, discussion 1336–1337.
13.
Abbott R: History of neuroendoscopy. Neurosurg Clin N Am 2004;15:17.
14.
Jallo GI, Kothbauer KF, Abbott IR: Endoscopic third ventriculostomy. Neurosurg Focus 2005;19:E11.
15.
Pople IK, Griffith HB: Control of hydrocephalus by endoscopic choroid plexus coagulation: long-term results and complications. Eur J Pediatr Surg 1993;3(suppl 1):17–18.
16.
Pople IK, Ettles D: The role of endoscopic choroid plexus coagulation in the management of hydrocephalus. Neurosurgery 1995;36:698–701, discussion 701–702.
17.
Morota N, Fujiyama Y: Endoscopic coagulation of choroid plexus as treatment for hydrocephalus: indication and surgical technique. Childs Nerv Syst 2004;20:816–820.
18.
Gangemi M, Donati P, Maiuri F, et al: Endoscopic third ventriculostomy for hydrocephalus. Minim Invasive Neurosurg 1999;42:128–132.
19.
Grunert P, Charalampaki P, Hopf N, et al: The role of third ventriculostomy in the management of obstructive hydrocephalus. Minim Invasive Neurosurg 2003;46:16–21.
20.
Hopf NJ, Gruntert P, Fries G, et al: Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures. Neurosurgery 1999;44:795–804, discussion 804–806.
21.
Jones RF, Kwok BC, Stening WA, et al: The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus. Minim Invasive Neurosurg 1994;37:28–36.
22.
Amini A, Schmidt RH: Endoscopic third ventriculostomy in a series of 36 adult patients. Neurosurg Focus 2005;19:E9.
23.
Dusick JR, McArthur DL, Bergsneider M: Success and complication rates of endoscopic third ventriculostomy for adult hydrocephalus: a series of 108 patients. Surg Neurol 2008;69:5–15.
24.
Gangemi M, Mascari C, Maiuri F, et al: Long-term outcome of endoscopic third ventriculostomy in obstructive hydrocephalus. Minim Invasive Neurosurg 2007;50:265–269.
25.
Guiot G: Ventriculo-cisternostomy for stenosis of the aqueduct of Sylvius: puncture of the floor of the third ventricle with a leucotome under television control. Acta Neurochir (Wien) 1973;28:275–289.
26.
Jones RF, Kwok BC, Stening WA, et al: Neuroendoscopic third ventriculostomy: a practical alternative to extracranial shunts in non-communicating hydrocephalus. Acta Neurochir Suppl 1994;61:79–83.
27.
Kelly PJ: Stereotactic third ventriculostomy in patients with nontumoral adolescent/adult onset aqueductal stenosis and symptomatic hydrocephalus. J Neurosurg 1991;75:865–873.
28.
Oka K, Yamamoto M, Ikeda K, et al: Flexible endoneurosurgical therapy for aqueductal stenosis. Neurosurgery 1993;33:236–242, discussion 242–243.
29.
van Beijnum J, Hanlo PW, Fischer K, et al: Laser-assisted endoscopic third ventriculostomy: long-term results in a series of 202 patients. Neurosurgery 2008;62:437–443, discussion 443–444.
30.
Di X, Ragab M, Luciano MG: Cine phase-contrast MR images failed to predict clinical outcome following ETV. Can J Neurol Sci 2009;36:643–647.
31.
Cinalli G, Spennato P, Savarese L, Ruggiero C, Aliberti F, Cuomo L, Cianciulli E, Maggi G: Endoscopic aqueductoplasty and placement of a stent in the cerebral aqueduct in the management of isolated fourth ventricle in children. J Neurosurg 2006;104(suppl 1):21–27.
32.
Enchev Y, Oi S: Historical trends of neuroendoscopic surgical techniques in the treatment of hydrocephalus. Neurosurg Rev 2008;31:249–262.
33.
Gawish I, Reisch R, Perneczky A: Endoscopic aqueductoplasty through a tailored craniocervical approach. J Neurosurg 2005;103:778–782.
34.
Erşahin Y: Endoscopic aqueductoplasty with and without stent. Minim Invasive Neurosurg 2006;49:124–125.
35.
Erşahin Y: Endoscopic aqueductoplasty. Childs Nerv Syst 2007;23:143–150.
36.
Hellwig D, Bauer BL, Schulte M, et al: Neuroendoscopic treatment for colloid cysts of the third ventricle: the experience of a decade. Neurosurgery 2003;52:525–533, discussion 532–533.
37.
Levine NB, Miller MN, Crone KR: Endoscopic resection of colloid cysts: indications, technique, and results during a 13-year period. Minim Invasive Neurosurg 2007;50:313–317.
38.
Greenlee JD, Teo C, Ghahreman A, et al: Purely endoscopic resection of colloid cysts. Neurosurgery 2008;62(suppl 1):51–55, discussion 55–56.
39.
Horn EM, Feiz-Erfan I, Bristol RE, et al: Treatment options for third ventricular colloid cysts: comparison of open microsurgical versus endoscopic resection. Neurosurgery 2007;60:613–618, discussion 618–620.
40.
Batjer HH, Reisch JS, Allen BC, et al: Failure of surgery to improve outcome in hypertensive putaminal hemorrhage: a prospective randomized trial. Arch Neurol 1990;47:1103–1106.
41.
Fernandes HM, Gregson B, Siddique S, et al: Surgery in intracerebral hemorrhage: the uncertainty continues. Stroke 2000;31:2511–2516.
42.
Juvela S, Heiskanen O, Poranen A, et al: The treatment of spontaneous intracerebral hemorrhage: a prospective randomized trial of surgical and conservative treatment. J Neurosurg 1989;70:755–758.
43.
Mendelow AD, Gregson BA, Fernandes HM, et al: Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 2005;365:387–397.
44.
Morgenstern LB, Frankowski RF, Shedden P, et al: Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial. Neurology 1998;51:1359–1363.
45.
Prasad K, Shrivastava A: Surgery for primary supratentorial intracerebral haemorrhage. Cochrane Database Syst Rev, 2000: CD000200.
46.
Bilbao G, Garibi J, Pomposo I, et al: A prospective study of a series of 356 patients with supratentorial spontaneous intracerebral haematomas treated in a Neurosurgical Department. Acta Neurochir (Wien) 2005;147:823–829.
47.
Hattori N, Katayama Y, Maya Y, et al: Impact of stereotactic hematoma evacuation on medical costs during the chronic period in patients with spontaneous putaminal hemorrhage: a randomized study. Surg Neurol 2006;65:429–435, discussion 435.
48.
Pantazis G, et al: Early surgical treatment vs conservative management for spontaneous supratentorial intracerebral hematomas: A prospective randomized study. Surg Neurol 2006;66:492–501, discussion 501–502.
49.
Teernstra OP, Evers SM, Kessels AH: Meta analyses in treatment of spontaneous supratentorial intracerebral haematoma. Acta Neurochir (Wien) 2006;148:521–528, discussion 528.
50.
Prasad K, Mendelow AD, Gregson B: Surgery for primary supratentorial intracerebral haemorrhage. Cochrane Database Syst Rev 2008:CD000200.
51.
Kobayashi S, Sato A, Kageyama Y, et al: Treatment of hypertensive cerebellar hemorrhage: surgical or conservative management? Neurosurgery 1994;34:246–250, discussion 250–251.
52.
Little JR, Tubman DE, Ethier R: Cerebellar hemorrhage in adults: diagnosis by computerized tomography. J Neurosurg 1978;48:575–579.
53.
Ohwaki K, Yano E, Nagashima H, et al: Surgery for patients with severe supratentorial intracerebral hemorrhage. Neurocrit Care 2006;5:15–20.
54.
Waidhauser E, Hamburger C, Marguth F: Neurosurgical management of cerebellar hemorrhage. Neurosurg Rev 1990;13:211–217.
55.
Yamamoto T, Nakao Y, Mori K, et al: Endoscopic hematoma evacuation for hypertensive cerebellar hemorrhage. Minim Invasive Neurosurg 2006;49:173–178.
56.
Mayer SA, Brun NC, Beqtrup K, et al: Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 2005;352:777–785.
57.
Auer LM, Deinsberger W, Niederkorn K, et al: Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg 1989;70:530–535.
58.
Miller CM, Vespa P, Saver JLet al: Image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage. Surg Neurol 2008;69:441–446, discussion 446.
59.
Nakano T, Ohkuma H, Ebina K, et al: Neuroendoscopic surgery for intracerebral haemorrhage: comparison with traditional therapies. Minim Invasive Neurosurg 2003;46:278–283.
60.
Hamada H, Hayashi N, Kurimoto M, et al: Neuroendoscopic removal of intraventricular hemorrhage combined with hydrocephalus. Minim Invasive Neurosurg 2008;51:345–349.
61.
Zhang Z, Li X, Liu Y, et al: Application of neuroendoscopy in the treatment of intraventricular hemorrhage. Cerebrovasc Dis 2007;24:91–96.
62.
Broderick JP, Brott T, Tomsick T, et al: Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg 1993;78:188–191.
63.
Broderick JP, Adams HP Jr, Barsan W, et al: Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 1999;30:905–915.
64.
Dolinskas CA, Bilaniuk LT, Zimmerman RA, et al: Computed tomography of intracerebral hematomas. 2. Radionuclide and transmission CT studies of the perihematoma region. AJR Am J Roentgenol 1977;129:689–692.
65.
Nath FP, Jenkins A, Mendelow AD, et al: Early hemodynamic changes in experimental intracerebral hemorrhage. J Neurosurg 1986;65:697–703.
66.
Kingman TA, Mendelow AD, Graham DI, et al: Experimental intracerebral mass: time-related effects on local cerebral blood flow. J Neurosurg 1987;67:732–738.
67.
Kim MH, Song JH, Kim SH, et al: A new trend in operative technique for intracerebral hemorrhage: a comparative study of stereotactic endoscopic removal and stereotactic catheter drainage. Neurosurg Focus 1996;1:e2, discussion e2.
68.
Nishihara T, Morita A, Teraoka A, et al: Endoscopy-guided removal of spontaneous intracerebral hemorrhage: comparison with computer tomography-guided stereotactic evacuation. Childs Nerv Syst 2007; 23:677–683.
69.
Hsieh PC, Cho DY, Lee YW, et al: Endoscopic evacuation of putaminal hemorrhage: how to improve the efficiency of hematoma evacuation. Surg Neurol 2005;64:147–153, discussion 153.
70.
Nagasaka T, Inao S, Ikeda H, et al: Inflation-deflation method for endoscopic evacuation of intracerebral haematoma. Acta Neurochir (Wien) 2008;150:685–690, discussion 690.
71.
Nishihara T, Nagata K, Tanaka S, et al: Newly developed endoscopic instruments for the removal of intracerebral hematoma. Neurocrit Care 2005;2:67–74.
72.
Nishihara T, Teraoka A, Morita A, et al: A transparent sheath for endoscopic surgery and its application in surgical evacuation of spontaneous intracerebral hematomas: technical note. J Neurosurg 2000;92:1053–1055.
73.
Fukushima T: Endoscopic biopsy of intraventricular tumors with the use of a ventriculofiberscope. Neurosurgery 1978;2:110–113.
74.
Kamikawa S, Inui A, Kobayashi N, et al: Endoscopic treatment of hydrocephalus in children: a controlled study using newly developed Yamadori-type ventriculoscopes. Minim Invasive Neurosurg 2001;44:25–30.
75.
Kamikawa S, Inui A, Asakawa A, et al: Histologic diagnosis and management of hypothalamic tumors in children by the use of newly developed flexible neuroendoscopes. Int J Oncol 2003;22:269–272.
76.
Chernov MF, Kamikawa S, Yamane F, et al: Neurofiberscopic biopsy of tumors of the pineal region and posterior third ventricle: indications, technique, complications, and results. Neurosurgery 2006;59:267–277, discussion 267–277.
77.
Fiorindi A, Longatti P: A restricted neuroendoscopic approach for pathological diagnosis of intraventricular and paraventricular tumours. Acta Neurochir (Wien) 2008;150:1235–1239.
78.
Souweidane MM, Sandberg DI, Bilsky MH, et al: Endoscopic biopsy for tumors of the third ventricle. Pediatr Neurosurg 2000;33:132–137.
79.
Yurtseven T, Ersahin Y, Demirtas E, et al: Neuroendoscopic biopsy for intraventricular tumors. Minim Invasive Neurosurg 2003;46:293–299.
80.
Veto F, Horvath Z, Doczi T: Biportal endoscopic management of third ventricle tumors in patients with occlusive hydrocephalus: technical note. Neurosurgery 1997;40:871–875, discussion 875–877.
81.
Robinson S, Cohen AR: The role of neuroendoscopy in the treatment of pineal region tumors. Surg Neurol 1997;48:360–365, discussion 365–367.
82.
Michielsen G, Benoit Y, Baert E, et al: Symptomatic pineal cysts: clinical manifestations and management. Acta Neurochir (Wien) 2002;144:233–242, discussion 242.
83.
Gaab MR, Schroeder HW: Neuroendoscopic approach to intraventricular lesions. J Neurosurg 1998;88:496–505.
84.
Depreitere B, Dasi N, Rutka J, et al: Endoscopic biopsy for intraventricular tumors in children. J Neurosurg 2007;106(suppl 5): 340–346.
85.
Yamini B, Refai D, Rubin CM, et al: Initial endoscopic management of pineal region tumors and associated hydrocephalus: clinical series and literature review. J Neurosurg 2004;100:437–441.
86.
Stein BM, Bruce JN: Surgical management of pineal region tumors (honored guest lecture). Clin Neurosurg 1992;39:509–532.
87.
Edwards MS, Hudgins RJ, Wilson CB, et al: Pineal region tumors in children. J Neurosurg 1988;68:689–697.
88.
Fritsch MJ, Kienke S, Manwaring KH, Mehdorn HM: Endo scopic aqueductoplasty and interventriculostomy for the treatment of isolated fourth ventricle in children. Neuro Surgery 2004;55:372–377, discussion 377–379.
89.
Torres-Corzo J, Rodriguez-Della Vecchia R, Rangel-Castilla L: Trapped fourth ventricle treated with shunt placement in the fourth ventricle by direct visualization with flexible neuroendoscope. Minim Invasive Neurosurg 2004;47:86–89.
90.
Upchurch K, Raifu M, Bergsneider M: Endoscope-assisted placement of a multiperforated shunt catheter: discussion. Neurosurg Focus 2007;22:E8.
91.
Warnke JP, Mourgela S: Endoscopic treatment of lumbar arachnoiditis. Minim Invasive Neurosurg 2007;50:1–6.
92.
Warnke JP, Mourgela S, Tschabitscher M, et al: Thecaloscopy. 2. Anatomical landmarks. Minim Invasive Neurosurg 2001;44:181–185.
93.
Warnke JP, Tschabitscher M, Nobles A: Thecaloscopy: the endoscopy of the lumbar subarachnoid space. 1. Historical review and own cadaver studies. Minim Invasive Neurosurg 2001;44:61–64.
94.
Warnke JP, Koppert H, Bensch-Schreiter B, et al: Thecaloscopy. 3. First clinical application. Minim Invasive Neurosurg 2003;46:94–99.
95.
Warnke JP, Di X, Mourgela S, et al: Percutaneous approach for thecaloscopy of the lumbar subarachnoidal space. Minim Invasive Neurosurg 2007;50:129–131.
96.
Bosscher HA, Heavner JE: Incidence and severity of epidural fibrosis after back surgery: an endoscopic study. Pain Pract 2010;10:18–24.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.