Endoscopic Neurosurgery in the 21st Century: A Comprehensive Review of Challenges and Prospects

Suraj Ethiraj *

Department of Surgery, SCB Medical College and Hospital, Cuttack, India.

Vignesh Varma

Department of Surgery, MS Ramaiah Medical College, Bangalore, India.

Soumith Subhash

Department of Surgery, Bokaro General Hospital, Bokaro, India.

*Author to whom correspondence should be addressed.


Endoscopic neurosurgery has emerged as a transformative paradigm in the field of neurosurgery. This comprehensive review article explores the evolution, current applications, advantages, challenges, and future prospects of endoscopic neurosurgery. Advantages of endoscopic neurosurgery are manifold. Its minimally invasive nature mitigates surgical trauma, reducing postoperative morbidity and hospitalisation times. Enhanced visualisation facilitates precise lesion targeting and minimises collateral damage. These factors culminate in expedited patient recovery and improved quality of life. However, endoscopic neurosurgery is not without its challenges. Surgeons must navigate a learning curve to master these techniques, and the acquisition of specialised equipment can be cost-prohibitive. Additionally, the application of endoscopy in complex and high-risk cases remains a subject of ongoing research. The future of endoscopic neurosurgery is illuminated by the promise of emerging technologies. Robotics and augmented reality are on the horizon, poised to expand the horizons of endoscopic procedures and further improve patient outcomes. Comprehensive training and education programs will play a pivotal role in equipping neurosurgeons with the skills required to navigate this evolving landscape effectively. In conclusion, endoscopic neurosurgery represents a dynamic shift in the neurosurgical paradigm. Despite challenges, its ongoing evolution and the advent of transformative technologies foreshadow a future where minimally invasive approaches will continue to redefine the boundaries of neurosurgical care, ensuring safer and more effective treatments for an array of complex neurological conditions.

Keywords: Endoscope, neurosurgery, neuroendoscope, minimally invasive surgery, robotics in neurosurgery

How to Cite

Ethiraj , S., Varma , V., & Subhash , S. (2024). Endoscopic Neurosurgery in the 21st Century: A Comprehensive Review of Challenges and Prospects. Asian Journal of Research and Reports in Neurology, 7(1), 34–41. Retrieved from https://journalajorrin.com/index.php/AJORRIN/article/view/101


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Apuzzo MLJ, Heifetz MD, Weiss MH, Kurze T. Neurosurgical endoscopy using the side-viewing telescope. J Neurosurg. 1977;46(3):398-400. DOI:10.3171/jns.1977.46.3.0398.

Hopkins LN, Holbery MA. The historical development of neuroendoscopy. Neurosurgery. 2000;46(3):651-658. DOI:10.1097/00006123-200003000-00033.

Frank G, Pasquini E, Farneti G, Mazzatenta D, Sciarretta V, Grasso V. The endoscopic versus the traditional approach in pituitary surgery. Neuroendocrinology. 2006;83(3-4):240-248 DOI:10.1159/000095602.

Gellad FE, Carrion E, Sciubba DM et al. Endoscopic management of ventricular neurocysticercosis: Case series and review of the literature. World Neurosurg. 2016;86:194-201. DOI:10.1016/j.wneu.2015.09.075.

Wu AM, Zhou Y, Li QL et al. Endoscopic surgery versus microsurgery for treating spinal intradural extramedullary tumors: A systematic review and meta-analysis. J Neurosurg Spine. 2018;30(2):248-260. DOI:10.3171/2018.6.SPINE171333.

Spiotta AM, Turner RD, Chaudry MI, Turk AS. Comparison of techniques for ventriculostomy catheter placement: Standard burr hole method versus frameless electromagnetic guidance in a cadaver model. J Neurosurg. 2010;113 (6):1191-1195. DOI:10.3171/2010.4.JNS091532.

Yano S, Kato Y, Fujii K. Advantages of neuroendoscopy: How to study neuroendoscopy. Asian J Endosc Surg. 2014;7(3):184-191. DOI:10.1111/ases.12106.

Reisch R, Perneczky A. Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery. 2005;57(4Suppl): 242-255. DOI:10.1227/01.neu.0000176646.69707.1b.

Alzhrani G, Alsulaiman A, Fiani B et al. Robotics in endoscopic neurosurgery: A comprehensive review. World Neurosurg. 2019;126:76-85. DOI:10.1016/j.wneu.2019.03.217.

Usluer G, Yilmaz ER, Musluman AM et al. Three-dimensional exoscopic neurosurgery: Implementation of exoscopic visualization in microneurosurgery. World Neurosurg. 2019;126:e883-e892. DOI:10.1016/j.wneu.2019.03.031.

Smith ZA, Gokaslan ZL, Shaffrey CI, et al. Minimally invasive surgery for the treatment of spinal metastasis: A review of the literature and evidence-based guidelines. Int J Surg Oncol. 2011;2011:1-8.


Sanmillán JL, Fernández-Carballal C, López-Hernández F et al. Microendoscopic discectomy for lumbar disc herniation: Surgical technique and immediate postoperative results in 22 patients. Neurocirugia (Astur). 2007;18(4):289-296. DOI:10.1016/s1130-1473(07)70116-0.

Sindou M, Wydh E, Jouanneau E. Neuroendoscopic transventricular surgery in children. Childs Nerv Syst. 2000;16(12):858-866. DOI:10.1007/s003810000325.

Nowinski D, Kulik G, Kuder T et al. Comparison of neuroendoscopic techniques in the treatment of colloid cysts. Minim Invasive Neurosurg. 2004;47(6): 327-332. DOI:10.1055/s-2004-835769.

Reichman J, Singer G. Endoscopic versus microscopic approach to pineal lesions: A series of 18 consecutive cases. Minim Invasive Neurosurg. 2009;52(1):12-16. DOI:10.1055/s-0028-1104540.

Kilburg C, Sullivan S, Espaillat R. Early experience with transnasal transsphenoidal endoscopic removal of nonfunctioning pituitary adenomas. South Med J. 2005;98(1):50-53 DOI:10.1097/01.smj.0000145874.22000.ea.

Di Somma A, D'Andrea G, Szeifert G et al. Endoscopic approach to large and giant pituitary adenomas. Surg Neurol. 2004; 61(4):321-331. DOI:10.1016/j.surneu.2003.09.030.

Recinos PF, Raza SM, Jallo GI. Recinos VR. Use of a minimally invasive tubular retraction system for deep-seated tumors in pediatric patients. J Neurosurg Pediatr. 2009;3(5):374-378 DOI:10.3171/2009.1.PEDS08400.

Watanabe E, Watanabe T, Manaka S, Mayanagi Y, Takakura K. Three-dimensional digitizer (neuronavigator): New equipment for computed tomography-guided stereotaxic surgery. Surg Neurol. 1987;27(6):543-547. DOI:10.1016/0090-3019(87)90179-8.

Rizvi T, Brar MS, Tewari A, Negassa A. Role of patient-centered care in improving surgical care quality. J Surg Res. 2018;228:232-242.


Zanaty M, Chalouhi N, Starke RM et al. Endovascular stroke intervention in young patients: Report of six cases and literature review. J Cerebrovasc Endovasc Neurosurg. 2015;17(3): 235-241. DOI:10.7461/jcen.2015.17.3.235.

Prabhu VC, Sharafuddin MJA, Cummings TJ et al. Endovascular recanalization of symptomatic chronic total occlusion of the internal carotid artery. J Neurointerv Surg. 2012;4(2):83-86. DOI:10.1136/neurintsurg-2011-010048.

Cruz JP, O'Kelly C, Kelly M et al. Development of a high-flow endovascular test occlusion model for canine basilar tip aneurysms. Part I: Technical aspects. Interv Neuroradiol. 2011;17(3): 255-263. DOI:10.1177/159101991101700305.

Park HK, Horowitz M, Jungreis C et al. Perforation during balloon angioplasty for intracranial atherosclerotic disease. Neurosurgery. 2004;54(3):577-582 DOI:10.1227/01.neu.0000109297.74611.66.

Levy EI, Hanel RA, Boulos AS et al. Comparison of periprocedure complications resulting from direct stent placement compared with those due to conventional and staged stent placement in the basilar artery. J Neurosurg. 2003; 98(2):263-272 DOI:10.3171/jns.2003.98.2.0263.

Molyneux A, Kerr R, Stratton I et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomised trial. Lancet. 2002;360(9342): 1267-1274. DOI:10.1016/S0140-6736(02)11314-6