Endoscope-assisted microneurosurgery for anterior circulation aneurysms using the angle-type rigid endoscope over a 3-year period

Abstract

In certain cases endoscopic-assisted microsurgery is an exceptional aid to the surgeon and must become part of the operating theatre equipment and kept on hand ready for use. The endoscope is, in our opinion, particularly useful in certain aneurysm localisations (internal carotid artery-anterior communicating artery [ICA-ACOMA]).

Minimally Invasive Microsurgery for Cerebral Aneurysms

“…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. 33,37 Clip repositioning was required in 6.9% to 11.4% of aneurysms because of incomplete neck obliteration, parent artery or perforator occlusion, and compression of surrounding neural structures.…”

“…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.…”

“…33,37 Clip repositioning was required in 6.9% to 11.4% of aneurysms because of incomplete neck obliteration, parent artery or perforator occlusion, and compression of surrounding neural structures. 33,37,38 Kalavakonda et al reported one IOR when the endoscope was used without temporary occlusion and recommended that close visualization of a ruptured aneurysm should be performed only during temporary occlusion. 37 Endoscope-assisted aneurysm surgery has been applied to the SOC.…”

“…37 Further limitations of neuroendoscopy include the lack of stereoscopic 3-dimensional vision, which is incomparable to the operating microscope, and the inability to operate bimanually without a fixed endoscope holder. 38 Intraoperative angiography using indocyanine green (ICG) has gained widespread acceptance to evaluate incomplete clipping and occlusion of surrounding vessels. After injection into a peripheral vein, ICG fluorescence is induced as the dye circulates through the cerebral vessels under near-infrared illumination and images are collected through an optical filter.…”

Ruptured Cerebral Aneurysms: An Update

“…With the development of the endoscope to the microsurgical management, endoscopicassisted microsurgery is an exceptional aid to the surgeon and become part of the operating theatre equipment with no complications [39]. The use of the endoscope to assist the microsurgical clipping of cerebral aneurysm has been reported [40,41].The rigid endoscope has been increasingly used during aneurysm surgery to plan surgical strategies and verify the regional anatomic features, neck anatomic features and perforators and verification of the optimal clip position.…”