Neuroendoscopy: How We Got Here.

From its inception in ancient Egyptian rituals, neuroendoscopy always promised a minimally invasive route to the cerebrum. Early visionaries, however, hit the proverbial wall of technical development until the 20th century, when new technologies allowed for light to be transmitted across a tube for visualization of intracranial structures. Despite a hiccupping start, with surgical microscopy hampering initial excitement, the development and transformation of neuroendoscopy continued, and today it is a widespread and reliable surgical option for the treatment of numerous varied and complex pathologies.

Microscopic and Endoscopic Skull Base Approaches Hands-On Cadaver Course at 30: Historical Vignette.

Laboratory-based cadaveric training is essential for the development and refinement of neurosurgical technical skills in the operating room and has become an integral training component around the world. Postresidency fellowship-the first pillar of skull base surgery training-includes both hands-on clinical care and surgery supervised by an experienced skull base surgeon. Time is spent in a skull base laboratory practicing approaches and developing anatomic mastery. The second pillar includes formal skull-base courses-institutional dissection laboratories provide continuous anatomic and surgical education while complementary annual or semiannual cadaver courses gather recognized experts to share their knowledge and experience in an essential 2- to 3-day setting. In this paper, we present the history of the longest running annual skull-base cadaver microsurgical course, which was started by Dr. Ossama Al-Mefty: Annual Surgical Approaches to the Skull Base Course. At the Microscopic and Endoscopic Hands-on Cadaver Workshop, held in St. Louis, Missouri, we celebrated its 30th anniversary in April 2019. We also present the impact this course has had on neurosurgery and skull base surgery and on the professional and scientific developments of its participants in particular.

Development of Cerebral Endoscopy in Italy: Background, Narration, and Legacy.

Bibliometric analysis shows that neuroendoscopy (NE) overcame its pioneering phase in the late 1980s, and became a significant technological and clinical innovation in the early 1990s. During those years the charge-coupled device digital video cameras were introduced and videoendoscopy had its decisive breakthrough, laying the foundation for NE take-off. NE can be considered an early product of artificial intelligence, as much as neuroimaging and neuronavigation. In Italy, cerebral NE started in 1993 and, despite a couple of years of relative delay, gained ground rapidly thanks also to the personal contribution of Michelangelo Gangemi (1949-2017), to whose memory this article is dedicated. In this paper we try to re-create the history of Italian NE through original documents and other testimonials, in the context of the general worldwide development of NE. The modality of its rapid diffusion throughout our peninsula seems a good paradigm of how cooperation without unnecessary competition can be rewarding and constructive.

Endoscopic Endonasal Transsphenoidal Surgery: History and Evolution.

In previous decades, extensive and disfiguring transfacial and/or transcranial approaches were used to reach the sellar and parasellar areas. However, these surgical routes were burdened by severe complications and high mortality rates. Recently, the development of endoscopic endonasal techniques has revolutionized the surgical strategies for approaching the sella and adjacent areas and increased the development of transsphenoidal surgery. With these techniques, surgeons have been able to overcome the visual limitations of the open surgical approaches and access areas previously hidden from view. After the contributions of the Pittsburgh duo, Carrau and Jho, pioneers of pure endoscopic surgery, our school began to implement this technique, introducing technical innovations and variations, describing the anatomical details and defining new routes, and playing a key role in its widespread clinical application.

Endoscopic skull base surgery: evaluation of current clinical outcomes.

Endoscopic skull base surgery is one of the most recent fields of neurosurgery. Successive innovations were developed throughout history so that the current concepts that rule this surgical field could be reached. The current paper presents the evolution of endoscopic surgery and its current results on the treatment of skull base tumor, based on a review of meta-analysis and clinical series. A PubMed search for articles published between January 1990 and January 2014 about "endoscopic skull base surgery", "endoscopic transsphenoidal approach", "endoscopic treatment of parasellar tumors" and "suprasellar lesions" was performed. According to the current data, endoscopic surgery seems to be superior to open and transsphenoidal microscopic removal of giant pituitary adenomas. Endoscopy is at least as successful as transsphenoidal microsurgery for the removal of pituitary adenomas and craniopharyngiomas. Transcranial open approaches, in the context of anterior midline skull base meningiomas, present higher rates of gross total resection, fewer complications and better clinical results than endoscopy approaches. The rate of postoperative CSF leakage has been significantly reduced with the introduction of new techniques such as the Hadad-Bassagasteguy flap but still represent one of the most important complications of this technique. Currently, selected tumors located at the anterior, middle and posterior fossa can be adequately assessed using the endoscope with low rates of postoperative CSF leaks. Endoscopic surgery has substantially evolved in the last decades through the collaboration of different teams around the world. The endoscope is now an essential tool in the neurosurgery armamentarium with great potential for new applications in the nearby future.

History, Current Situation, and Future Development of Endoscopic Neurosurgery in China.

OBJECTIVE: During the past few decades, Chinese endoscopic neurosurgery has rapidly developed in synchrony with the rest of the world. The aim of this article is to review the development of Chinese endoscopic neurosurgery, including its birth, growth, current situation, and prospects. METHODS: The history of Chinese endoscopic neurosurgery development can be divided into 3 stages: cognition and initial stage (1964-1995), exploration and maturity stage (1995-2006), and rapid development and promotion stage (2006-present). RESULTS: In the first stage, we mainly began to become aware of endoscopic neurosurgery from the translation and review of literature. In the mid to late 1990s, Chinese neurosurgery pioneers began using neuroendoscopic techniques. In the following decade, many leading neurosurgeons made persistent efforts to push the development of Chinese endoscopic neurosurgery forward, focusing on advocating for and promoting and popularizing neuroendoscopic technology. In the rapid development and promotion stage, many representative national and regional neurosurgical centers became skilled and efficient in the application of neuroendoscopic technology and became new advocates of the technology. The number of cases, level of technology, and treatment effectiveness are gradually nearing international standards. However, future development requires promotion of balanced development to decrease regional disparities, further strengthen international exchanges, follow the latest developments, and constantly innovate for continuous improvement. CONCLUSIONS: Following the dramatic efforts of several pioneers, development of Chinese endoscopic neurosurgery has been considerable, and it has become an important component of neurosurgery worldwide.

Endoscopic third ventriculostomy: A historical review.

BACKGROUND: Endoscopic third ventriculostomy (ETV) has become one of the most common neuroendoscopic procedures. METHODS: In this article, we will review the major milestones in the history of ETV development from its early use by Walter Dandy to the techniques currently employed with advanced technology. CONCLUSIONS: ETV has become an important technique in the armamentarium of the neurosurgeon. From a meager beginning with few applications, our knowledge of long-term outcomes has evolved. ETV has a rich history and more recently, has had a renewed interest in its use. Our current understanding of its indications is growing and is based on a century of development through trial and error.

A journey into the technical evolution of neuroendoscopy.

Neuroendoscopy has become a well-accepted technique in neurosurgery. After the introduction of the endoscope in medical practice by Phillip Bozzini in 1806, influential individuals such as Harold Hopkins and Karl Storz paved the way for its current success. With the present pace of technologic advancements, great improvement in the instrumentation is expected along with the status of neuroendoscopy in the neurosurgical field. Specific attention is given to the history of the development of the endoscope, while also discussing more recent advances dating from 1990 onward. The importance of each development for the purpose of the instrument is explained. Gaps in the literature regarding the technical aspects of neuroendoscopy, including the optical physics in the endoscope, three-dimensional endoscopy, and clinical applications of neuroendoscopy and robotics, are addressed.

The origin and evolution of neuroendoscopy.

INTRODUCTION: Neuroendoscopy has become an integral field within neurosurgery. It has allowed neurosurgeons unprecedented access to deep structures within both the cranial and spinal compartments, while allowing for minimal incisions, tissue retraction, and postoperative healing time. DISCUSSION: In this article, we trace the origins of this vital field to ancient times, and show that much of its success is due to the brilliant minds of some luminaries such as Philipp Bozzini and Harold Hopkins. Through close collaborations between clinicians, scientists, and engineers neuroendoscopy has become an invaluable tool in the armamentarium of neurosurgeons to help solve a wide array of clinical problems.

"Through the looking glass": optical physics, issues, and the evolution of neuroendoscopy.

Although the concept of endoscopy has existed for centuries, a practical, working neuroendoscopic system did not emerge until last century, as a result of numerous contributions and refinements in optical technology, illumination sources, and instrumentation. Modern neuroendoscopy would not be a flourishing field, as it is today, without the dedication, innovation, and implementation of emerging technology by key contributors including Maximilian Nitze, Walter Dandy, and Harold Hopkins. Despite several inherent and unique limitations, neuroendoscopic surgery is now performed for a variety of intraventricular, skull base, and spinal operations. In this review, the history of neuroendoscopy, key players who envisioned how the inner workings of the human body could be visualized "through the looking glass," and current state and future potential for neuroendoscopic surgery are discussed. Future directions of neuroendoscopic surgery will likely be guided by further miniaturization in camera and optical technology, innovations in surgical instrumentation design, the introduction of robotics, multi-port minimally invasive surgery, and an enhanced ability to perform bimanual microdissection.

Celebrating the golden anniversary of anterior skull base surgery: reflections on the past 50 years and its historical evolution.

With its inception nearly half a century ago through the pioneering work of Dandy, McLean, and Smith, anterior skull base (ASB) surgery is a relatively young discipline. It became a distinct entity in 1963 when Ketcham popularized the combined transcranial transfacial approach for en bloc resection of tumors of the paranasal sinuses extending into the anterior cranial fossa. However, because these procedures resulted in major morbidities and mortalities, alternative modes of treatment were sought. Since the 1970s, the introduction and promotion of the surgical endoscope by Messerklinger, Stammberger, and Kennedy, commenced the era of endoscopic sinus surgery. Thaler and colleagues described the utility of the endoscope for ASB surgery at the turn of the century. This allowed direct visualization and safer, more accurate removal of tumors. In 2001, Casiano reported the first purely endoscopic endonasal ASB resection, a novel technique that has been adopted by major skull base centers. The success of ASB surgery can be attributed to both the development of the skull base team as well as improvements in surgical techniques, instrumentation, and visualization technology. In this article, we review the historical evolution of ASB surgery as we approach the 50th anniversary since its recognition as a distinct entity.

A history of ventricular neuroendoscopy.

OBJECTIVE: To describe the history of neuroendoscopy through the history of the major neurosurgeons who worked and published in the field. METHODS: All relevant data described in publications before 1980 about the history of neuroendoscopy and found through OVID MEDLINE searches and related references are reported. RESULTS: Contributions of 14 neurosurgeons who were pioneers in neuroendoscopy are described in chronologic order: Lespinasse, Dandy, Payr, Mixter, Fay, Grant, Volkmann, Putnam, Dereymacker, Scarff, Feld, Guiot, Fukushima, and Griffith. CONCLUSIONS: An historical review of ventricular neuroendoscopy remains by essence incomplete. Medical technical progress proceeds by leaps and bounds, related to the ingenuity of surgeons able to understand rapidly the value of a technical change to improve their surgical procedure. The ability to remain attentive to patients and evolving pathologies as well as the evolution of modern technology is required to make further progress in neuroendoscopy.

Neuroendoscopy: general aspects and principles.

When used in medicine, endoscopy describes a procedure used to see inside various parts of the body, such as the interior surfaces of an organ, by inserting a tube through a natural or created orifice. The instrument may have a rigid (borescope) or flexible (fiberscope) tube; it provides an image for visual inspection, photography and video-endoscopy and enables acquisition of biopsy specimens, removal of lesions, and retrieval of foreign objects. It is imperative that young neurosurgeons and residents become familiar and comfortable with endoscopic techniques, and it is hoped that they can contribute to the evolution and development of these surgical methods.

A lesson in history: the evolution of endoscopic third ventriculostomy.

The history of endoscopic third ventriculostomy (ETV) demonstrates the importance of studying neurosurgery's history. A story that began with numerous technological advancements started to fizzle as neurosurgeons were stymied by problems encountered during the infancy of the technology they were still developing. The new technique, although sound in theory, failed to deliver a realistic solution for managing hydrocephalus; it lost the battle to the valved shunt. Over the last 15-20 years, a clearer understanding of pathophysiological mechanisms underlying various forms of hydrocephalus, along with effective implementation of evidence-based practice, has allowed for optimization of patient selection and a remarkable improvement in ETV success rates. Neurosurgeons would be wise to take the lessons learned in modernizing the ETV procedure and reassure themselves that these lessons do not apply to other methods that are tempting to dismiss as antiquated or archaic.

"Through the looking glass": optical physics, issues, and the evolution of neuroendoscopy.

Although the concept of endoscopy has existed for centuries, a practical, working neuroendoscopic system did not emerge until last century, as a result of numerous contributions and refinements in optical technology, illumination sources, and instrumentation. Modern neuroendoscopy would not be a flourishing field, as it is today, without the dedication, innovation, and implementation of emerging technology by key contributors including Maximilian Nitze, Walter Dandy, and Harold Hopkins. Despite several inherent and unique limitations, neuroendoscopic surgery is now performed for a variety of intraventricular, skull base, and spinal operations. In this review, the history of neuroendoscopy, key players who envisioned how the inner workings of the human body could be visualized "through the looking glass," and current state and future potential for neuroendoscopic surgery are discussed. Future directions of neuroendoscopic surgery will likely be guided by further miniaturization in camera and optical technology, innovations in surgical instrumentation design, the introduction of robotics, multi-port minimally invasive surgery, and an enhanced ability to perform bimanual microdissection.