[Head-up Surgery in Current Neurosurgery with Neuroendoscope and Exoscope]

Neurological surgery requires techniques and equipment to magnify the delicate brain structures and blood vessels that are difficult to discern with the naked eye. The introduction of surgical microscopes in the 1960s marked a breakthrough leading to the development of microsurgery and significant improvements in the safety and efficacy of neurosurgery. Subsequently, minimally invasive neurosurgery became prevalent, particularly with advancements in endoscopic technology in the 1990s. Initially met with skepticism, neuroendoscopy progressed alongside device development, gaining consensus on its utility. In the 2010s, exoscope technology emerged, offering high-definition 3D visualization, and reducing surgeon and patient restrictions compared to traditional microscopes. Heads-up neurosurgery involves projecting the surgical field onto a monitor using a neuroendoscope and an exoscope, allowing the surgeon to perform the operation while looking at the front monitor with the head raised in a relaxed, natural posture. Heads-up surgery using neuroendoscopy and an exoscope offers many advantages over traditional microscopic surgery and is expected to enhance surgical outcomes through the integration of these advanced technologies, potentially becoming a significant breakthrough in neurosurgery. This article provides an overview of the latest heads-up procedures that utilize neuroendoscopy and exoscopy. (Received May 2, 2024; Accepted June 21, 2024; Published November 1, 2024).