Neuroendoscopy was first introduced in the year 1910 when Victor Darwin – A Chicago Urologist – penetrated the lateral ventricles of two hydrocephalic children with a rigid cystoscope to fulgurate the choroid plexus in an attempt to decrease Cerebro-Spinal Fluid (CSF) production. These neuroendoscopic procedures did not gain wide acceptance and were largely abandoned primarily because of equipment limitations and high surgical morbidity and morality. In recent years, with technological advances in the optics and miniaturization, there has been a resurgence of interest in the technique of neuroendoscopy. Neuroendoscopic procedures have great advantages in dealing with tissue sampling and gross morphological analysis of ventricular and cisternal structures, tumours or infective lesions. In addition, the endoscope holds the promise of shorter operative time, reduced blood loss, early recovery and shortened hospital stay with improved postoperative outcome. Successful anesthetic management for endoscopic brain surgery starts with understanding the unique anatomy of the ventricular system and subarachnoid space providing suitable conditions for the use of endoscope, the surgical technique, instrumentations, anesthetic requirements and potential pitfalls and complications.