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Endoscopy in Aneurysm Surgery

Fischer, Gerrit MD*,‡; Oertel, Joachim MD; Perneczky, Axel MD*,†

doi: 10.1227/NEU.0b013e3182376a36
Operative Nuances
CNS University of Neurosurgery

BACKGROUND: Surgical clipping with complete occlusion of the aneurysm and preservation of parent, branching, and perforating vessels remains the most definitive treatment for intracranial aneurysms.

OBJECTIVE: To evaluate the benefit of endoscopic application during microsurgical procedures in a retrospective study.

METHODS: One hundred eighty aneurysms were microsurgically treated in 124 operations. Three different applications of endoscopic visualization were used, depending on the respective requirements: inspection before clipping, clipping under endoscopic view, and postclipping evaluation.

RESULTS: Of 1380 aneurysms, 292 procedures were done with application of the endoscope. Of these 292, a complete data set, including video recording of the procedures for retrospective evaluation, was available in 180 cases. In these, the endoscope provided a favorable enhancement of the visual field, particularly in complex or deep-seated lesions. No adverse effects were observed. Before clipping, the endoscope was used to gain additional topographic information in 150 of 180 cases (83%). Clipping under endoscopic view was performed in 4 cases. After clipping, endoscopic inspection was performed in 130 of 180 procedures. Depending on the endoscopic findings, rearrangement of the applied clip or additional clipping was found to be necessary in 26 of 130 cases (20.0%).

CONCLUSION: 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.

Abbreviations: ACA, anterior cerebral artery

AChoA, anterior choroidal artery

AComA, anterior communicating artery

AICA, anterior inferior cerebellar artery

BA, basilar artery

DSA, digital subtraction angiography

ICA, internal carotid artery

MCA, middle cerebral artery

OphthA, ophthalmic artery

PCA, posterior cerebral artery

PComA, posterior communicating artery

PICA, posterior inferior cerebellar artery

SCA, superior cerebellar artery

VA, vertebral artery

*Neurochirurgische Klinik, Universitaetsmedizin, Johannes Gutenberg-Universitaet, Mainz, Germany

Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg-Saar, Germany

Correspondence: Gerrit Fischer, MD,Klinik für Neurochirurgie,Universitätsklinikum des Saarlandes,Kirrberger Strasse,D-66421 Homburg-Saar, Germany. E-mail:

† Deceased.

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Received November 9, 2010

Accepted October 9, 2011

Copyright © by the Congress of Neurological Surgeons