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Background: Fully endoscopic or endoscope-controlled approaches are essentially keyhole approaches in which rigid endoscopes are the sole visualization tools used during the whole procedure. At the early attempts of endoscope-assisted cranial surgery, it was noted that rigid endoscopes enabled overcoming the problem of suboptimal visualization when small exposures are used. The technical specifications and design of the currently available rigid endoscopes are associated with a group of unique features that define the endoscopic view and lay the basis for its superiority over the microscopic view during brain surgery. Fully endoscopic resection of intraparenchymal brain tumors is a minimally invasive approach that is not routinely practiced by neurosurgeons, with a few major series published so far. Unfamiliarity with the technique, steep learning curve, and concerns about inadequate exposure and decreased visibility may explain this fact. The majority of the purely endoscopic resections for intraparenchymal brain lesions are performed nowadays through tubular retractor systems. In very limited instances, however, the fully endoscopic technique is performed without tubular retractors. In this chapter, we elaborate on the surgical technique and nuances of the fully endoscopic nontubular retractor approach for intraaxial tumors., Methods: From a prospective database of endoscopic procedures maintained by the senior author, clinical data, imaging studies, and operative charts and videos of cases undergoing fully endoscopic excision for intraaxial brain tumors were retrieved and analyzed. The pertinent literature was also reviewed., Results: The surgical technique of the fully endoscopic nontubular retractor approach for intraaxial tumors was formulated., Conclusion: The endoscopic technique has many advantages over the conventional procedures. In our hands, the technique has proven to be feasible, efficient, and minimally invasive with excellent results., (© 2024. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

Background: The main criticism of endoscopic excision of colloid cysts of the third ventricle is the decreased ability to completely resect the cyst wall, therefore increasing the risk of recurrence. The extent of resection varies widely across the endoscopic series and is largely influenced by the surgical technique. We report the results of the rotational technique for endoscopic transforaminal excision of colloid cysts in a series of consecutive patients. Our objective is to contribute to the current literature and to shed more light on an effective and safe yet less commonly used technique., Methods: Retrospective analysis was performed on 19 patients. Preoperative magnetic resonance imaging (MRI) was evaluated for cyst characteristics. Postoperative MRI was evaluated for residual cyst membranes. Operative records were reviewed for residual cyst components. Excision grade was determined based on the Barrow Neurological Institute grading scale. Symptom resolution was documented clinically., Results: The study included 13 men and 6 women, with a mean age of 35 years (range, 19-56 years) and mean follow-up of 27.74 months (range, 4-55 months). Total excision was achieved in 17 of 19 cysts (89.5%). A small residual was seen intraoperatively but not radiographically in 1 patient. In another patient, residual cyst membrane seen intraoperatively and radiologically led to recurrence 18 months postoperatively. No mortalities or permanent morbidities occurred., Conclusions: Our high total excision rate and low complication profile are in concordance with the recent reports of endoscopic resection of colloid cysts. The rotational technique for the endoscopic transforaminal approach is highly effective and a safe alternative to the bimanual dissection technique., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Although the ventricular size is significantly reduced after endoscopic third ventriculostomy (ETV) in most successfully treated patients, ventricular size reduction is not always seen after a successful ETV. Practical and reliable radiologic parameters are still needed to assess the clinical success of an ETV., Methods: We retrieved the clinical and radiologic data of patients who underwent an ETV. Patients with the following criteria were included: (1) preoperative magnetic resonance imaging studies available, (2) postoperative magnetic resonance imaging studies done within the first 2 postoperative weeks, and (3) the infundibular recess clearly visible on preoperative and postoperative sagittal magnetic resonance imaging. Preoperative and postoperative measurements of the angle of the infundibular recess of the third ventricle were performed on midsagittal T1-weighted, T2-weighted, fast imaging employing steady-state acquisition, or constructive interference in steady state images., Results: The extent of reduction of the infundibular recess angle predicted the clinical outcome of ETV during the early postoperative period with a high degree of accuracy. The average reduction was about 48% in successful procedures versus only 15% in failed procedures., Conclusions: The degree of reduction of the angle of the infundibular recess of the third ventricle correlated with the amount of third ventricular decompression after ETV. Most importantly, such a reduction was noted to occur during the early postoperative period when radiologic changes are less pronounced. Assessment of change in infundibular recess angle measurement is easy to perform and may prove helpful in cases with no clear-cut clinical evidence of success of ETV., (Copyright © 2015 Elsevier Inc. All rights reserved.)