Application of a rigid endoscope to the microsurgical management of 54 cerebral aneurysms: results in 48 patients

Abstract

It is the authors' impression that the use of the endoscope in the microsurgical management of cerebral aneurysms enhanced the safety and reliability of the surgery. However, there is a prerequisite for the surgeon to be familiar with this instrumentation and fully prepared for the risks and inconveniences of endoscopic procedures.

Minimally Invasive Microsurgery for Cerebral Aneurysms

“…Post-clipping evaluation ensures that the aneurysm is completely obliterated, and the perforating vessels and surrounding neural structures are intact where the clip may obstruct direct microscopic view. 33,34 Several case series have evaluated the usefulness of endoscopy assistance for aneurysm surgery in association with PTC. 33,37,38,40 Greater anatomic clarification was identified with endoscopy in 81.5% to 94.9% of aneurysms, but interestingly, information obtained exclusively through endoscopy was found in only 16.7% to 19.0% of aneurysms.…”

“…34 Therefore, they may complement the standard operating microscope, which is restricted to illumination and magnification along a line of sight. 33 From a neuroanatomical perspective, the endoscope is ideal for visualizing aneurysms arising medially from the ICA, where the direct line of sight is obstructed by ICA or optic apparatus. 35 Using 0°-and 45°-4 mm and 30°-2.7 mm endoscopes on cadaveric specimens, Peris-Celda et al evaluated the additional endoscopic exposure and available working room at common aneurysm sites.…”

“…Its utility as an adjunct to microsurgical operations has been promoted by Perneczky and Fries. 32,33 Modern neuroendoscopes provide excellent illumination in the depth of the surgical field, clear depiction of anatomic details, and extended viewing angles with the ability to see around corners, especially with angled lenses. 34 Therefore, they may complement the standard operating microscope, which is restricted to illumination and magnification along a line of sight.…”

“…36 Subsequent clinical series have used a rigid neuro-endoscope with 0°, 30°, 70°, and 110° view angles. 33,34,[37][38][39][40] In endoscopeassisted craniotomies, the majority of the dissection and exposure is performed with the operating microscope, regardless of whether PTC or a mini-craniotomy is used. The endoscope has 3 applications during aneurysm surgery: inspection before clipping, clipping under endoscopic view, and postclipping evaluation.…”

New Device for Endoscopic Image Display During Microsurgical Clipping of Cerebral Aneurysms-Technical Note-

“…1,4,5,11) The advantages of this so-called``endoscope-assisted microsurgery'' 3) include increased light intensity, clear depiction of details in close-up positions, and extended viewing angle. 7) Both microscopic and endoscopic images must be monitored simultaneously during the procedure to obtain more complete information from the surgical field and to avoid inadvertent tissue injury due to inaccurate handling of the endoscope.…”