Endoscopy in Aneurysm Surgery

Abstract

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.

Minimally Invasive Microsurgery for Cerebral Aneurysms

“…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. 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.…”

“…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.…”

“…The endoscope has 3 applications during aneurysm surgery: inspection before clipping, clipping under endoscopic view, and postclipping evaluation. 34 Use of the neuroendoscope before clipping permits a greater appreciation of the regional anatomy, particularly of structures obscured from direct microscopic view. This may reduce unnecessary maneuvers to retract and dissect around the aneurysm and may also reduce the duration of temporary clipping.…”

“…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.…”

Endoscopic anatomical study on anterior communicating artery aneurysm surgery by endonasal transphenoidal approach

“…Although they are very mature, both of them have disadvantages, such as surgical injury, incomplete clipping, infection, hydrocephaly or even serious complications sometimes. However, endonasal transphenoidal approach with neuroendoscopy has its own advantage, such as direct access, minimally invasive, less bleeding, light pain, quick recovery, better visualization of the anterior communicating artery aneurysm and so on [1][2][3]. Besides, endonasal transphenoidal approach with neuroendoscopy is more minimally invasive and can reduce postoperative complications.…”