Actual state of EndActive ventricular endoscopy

Purpose We assessed usability and applicability of a rigid, multidirectional steerable videoendoscope (EndActive, Karl Storz GmbH, Tuttlingen, Germany) for endoscopic third ventriculostomy and compared our experience with reports about other multidirectional endoscopes. Methods The prototype is a 4-mm-diameter rigid videoendoscope with an integrated image sensor comprising an embedded light source, offering a free viewing direction in a range of 160° while the tip itself does not move. In five specimens (ten sides), we introduced the endoscope via precoronal burr holes through the lateral ventricle and foramen of Monro into the third ventricle. The endoscope's tip was positioned at the level of the mamillary bodies and the previously defined anatomical target structures; anteriorly, the optic chiasm, anterior commissure, infundibulum, tuber cinereum and posteriorly, the entrance to the mesencephalic aqueduct and posterior commissure were inspected. Results A single insertion of the videoendoscope was sufficient to explore with the multiplanar viewing mechanism the entire third ventricle. The prototype videoendoscope may be held like a microsurgical instrument in one hand. It is feasible to control movements precisely due to the reduced weight and ergonomic shape of the device. Conclusions The prototype EndActive has the potential to fit in the current concept of ETV and enrich the setting adding working economy and viewing variability.