Summary:Endoscopic neurosurgery has been practiced for >80 years but with equipment designed for other specialties. It is only recently that specific neuroendoscopes and their ancillary equipment have become available. This communication reviews the current state of the art. Rigid or flexible endoscopes may be used, separately or together, to visualize the cerebral ventricles, brain parenchyma, cysts, cranial or spinal epidural and subarachnoid spaces, subdural hematomas, thoracic and peritoneal cavities together with the inside of cerebral arteries, spinal cord (syrinx), intervertebral disk, and carpal tunnel. In these situations it is possible to perform inspection, biopsy, aspiration, resection, vaporization, coagulation, fenestration, intubation, removal of foreign bodies, and microvascular decompression. Well-documented therapeutic success rates exist for communicating hydrocephalus (by choroid plexus coagulation) of 52–80%. for late onset noncommunicating hydrocephalus (by third ventriculostomy) of 82–94%, for thoracic sympathectomy of 95%, and for lumbar diskectomy of 95%. Success in smaller series has been claimed in cases of arachnoid cyst, colloid cyst of the third ventricle, intracerebral tumor, intracerebral and multilocular subdural and epidural hematoma, cerebrospinal fluid (CSF) fistula, multiseptate syringomyelia, and carpal tunnel syndrome. In addition, the first recorded cases of endoscopic hypophysectomy and endoscopic revision of encysted peritoneal shunt catheter are described.