The Supraorbital Endoscopic Approach for Aneurysms

Minimally Invasive Microsurgery for Cerebral Aneurysms

“…The authors commented that without endoscopy, the incomplete clipping and perforator occlusion rates would have been 18.9% and 8.3%, respectively. A larger series of 989 ruptured and unruptured aneurysms treated with endoscope-assisted SOC was also presented by Reisch et al 39 Favorable outcome scores (mRS≤2) for ruptured and unruptured aneurysm cohorts were present in 72.2% and 96.6%, respectively. Suboptimal or incorrect clip position was detected in 19.1% of aneurysms, which were subsequently corrected.…”

“…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.…”

“…37 Endoscope-assisted aneurysm surgery has been applied to the SOC. 34,39 Fischer et al reported 180 aneurysms in which the endoscope was used before clipping (150 cases), during clipping (4 cases), and after aneurysm clipping (130 cases). 34 No adverse events related to endoscopy were observed.…”

A raised bar for aneurysm surgery in the endovascular era

“…The field of skull base and cerebrovascular surgery has witnessed a transition from large craniotomies that provided extensive views of the anatomy at the skull base to more tailored approaches that minimize brain exposure while continuing to provide adequate visualization without marginalizing safety. 11,14,26,29 The trend toward miniaturization of craniotomies stems from patient demand for better cosmesis. 30 Improvements in microscopes and surgical instrumentation and the incorporation of neuronavigation into surgical treatment paradigms for aneurysms have allowed surgeons to expose vascular lesions safely while minimizing morbidity to the adjacent brain.…”

Keyhole Approach and Neuroendoscopy for Cerebral Aneurysms

“…Neuroendoscopy was implemented to treat aneurysms in the early 1990s, and its role has become widespread from assisting microscopy procedures to providing the main view. In selected cases, aneurysm clipping has evolved from endoscope-assisted procedures to endoscope-controlled ones1,14), and neuroendoscopy is progressively used via the keyhole13,33) and endonasal12,15,16,35) approaches as well as conventional approaches. Endoscopic endonasal approaches are thought to be a good alternative for aneurysms located in the medial paraclinoid segment of the internal carotid artery (ICA) and posterior circulations such as basilar bifurcation, as well as those in cerebellar and vertebral arteries, which are limited with conventional surgical approaches35).…”