BACKGROUND: Contact endoscopy (CE) is a visualization technique with high magnification power, facilitating the in vivo examination of biological tissue morphology during different endoscopic-assisted procedures. Although its widespread implementation remains limited in neurosurgery, CE has emerged as a novel visualization tool, with several reports in the literature documenting its adoption. METHODS: The functionality and limitations of CE were investigated using six formalin-fixed heads (twelve sides) and in two patients with both intra- and extra-axial lesions to comprehensively evaluate the effectiveness and potential limitations of CE in real-world clinical scenarios. Furthermore, a standard Karl Storz endoscope - 0°, 4 mm in diameter, and 18 cm in length - was adopted as a mean of comparison. RESULTS: CE provided a magnified, real-time visualization of targeted areas, facilitating the identification of the interface between pathologic and normal tissue. The recognition of distinctive vascular patterns represented a reproducible benefit of the CE. Despite presenting a steep learning curve and being limited by higher distal tip temperatures, the contact endoscope does not demonstrate significant maneuverability differences from other standard endoscopes. CONCLUSION: The present study serves as a practical "technical guide" for utilizing CE visualization in neurosurgery, providing useful information on optimizing its potential by detailing the specific and complex features of the endoscope itself, including guidance on proper handling and usage techniques in neurosurgery to enhance its effectiveness.