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Page 12 of 19 Shaikh et al. Mini-invasive Surg 2020;4:89 I http://dx.doi.org/10.20517/2574-1225.2020.97

Figure 14. Angled suction tips for cavernous sinus and other areas

cellulose (Surgicel from Ethicon). Newer hemostats have also been introduced with proven benefit in
neuroendoscopy such as fibrin sealant (Tisseel from Baxter, Evicel from J&J) and gelatin-thrombin matrix
sealant (FloSeal from Baxter) [73,74] .

Specialized instruments
Ergonomically designed instruments for endonasal surgeries include concealed retractable knife, rotatable
scissors for dural incision, curved keyhole and non-keyhole graded suctions, disc dissectors, fine dissectors,
ring curettes of varying angles for tumor separation, and pistol grip endoscopic bipolars which can be
rotated to adjust the axis of the distal cauterizing tips into a horizontal or vertical plane. Neurosurgeons
contributing with instruments for facilitating skullbase endoscopy include Amin Kassam’s specialized bipolar
[75]
and suction device and Paolo Cappabiancas’ retractable knife. We have developed our own angled suction
sets [Figure 14], malleable keyhole suction and malleable silver dissector [Figure 15], curettes [Figure 16],
and bipolar forceps without sliding movement [Figure 17], as shown in Figures 15-17.

Shuntoscope and new fiberoptic scopes
Semi rigid shunt scope systems [Figure 18] by Karl Storz, Germany have been shown to achieve a more
accurate catheter placement, especially in pediatric patients with slit ventricles . The next generation
[76]
fiberoptic neuroendoscopy with “chip on tip” camera combines the best of both flexible and rigid scopes.
They were originally developed for bronchoscopy and provide excellent visualization and flexibility to work
in the lamina terminalis, temporal horns, fourth ventricle, etc., which are not easily accessible by rigid