The overall outcome, rate of retreatment, and approach-related complications with keyhole approaches for the management of ruptured and unruptured aneurysms are comparable to recently published conventional surgical aneurysm series. In addition to the common benefits of limited-exposure approaches, this series demonstrates appropriate safety and applicability of the keyhole technique in aneurysm surgery.
Endoscopic enhancement of the visual field provided by the endoscope before, during, and after microsurgical aneurysm occlusion may be a safe and effective application to increase the quality of treatment. Although unexpected findings concerning completeness of aneurysm occlusion and compromise of involved vessels could be diminished by endoscopic assessment, total prevention was not accomplished.
Both techniques have specific drawbacks that could be compensated by each other, to a certain extent. Intraoperatively, ICG-VA and mDs should not be considered competitive, but complementary. This study implicates that the combination of both applications on a routine basis assures the quality of aneurysm surgery by nearly noninvasive and cost-effective techniques. However, DSA remains the gold standard for evaluation of aneurysm occlusion.
Findings suggest alteration of the CBF/CMRO₂ ratio by propofol in cortical brain regions; therefore, it might be possible that propofol affects coupling of flow and metabolism in the cerebral microcirculation.
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