Neuroendoscope in Aneurysm Surgeries

Abstract

Even with the use of most sophisticated microscope sometimes the relationship between the aneurysm and the adjacent structures are not clearly defined. The straight line of view by microscope results in inadequate visualization of structures that lie immediately behind other structures like the neck, branches or perforators of the aneurysm. Hence exposure of these structures may require risky retraction either of the parent artery or the aneurysm itself, which can be overcome by clear anatomical information obtained by the use of endoscope instead of attempting extensive manipulation under the microscope. The endoscope permits close up, wide angled views of regional anatomic features and verification of the optimal clip position. Visual conformation of regional anatomy achieved using the rigid endoscope provides valuable information for subsequent microsurgical procedures and enhances the safety and reliability. Endoscopic-assisted microsurgery is an exceptional aid and using the PIP (picture-in picture) technology, simultaneous observation of microscope and endoscopic images can be viewed through the ocular system of microscope. The advantages of neuroendoscope include the ability to look around corners and behind obstructions. With less brain retraction, smaller operative exposures and better visualization, neuroendoscopy may reduce operative morbidity. However the surgeon should be familiar with this technique and be prepared for the inconveniences and risks during the procedure.

Microsurgical clipping of the anterior circulation aneurysms

“…The technical advances of such procedures are improving the results and it is superior to the microsurgical clipping in selected cases, especially in the posterior circulation and intracavernous aneurysms. (1,2,9,10,16,18,19,29,32) Older patients, the patients with poor neurological conditions at the initial hospital management are treated with lesser risks by endovascular coiling. The complexity of the microsurgical training to prepare a neurosurgeon to deal with aneurysms of the brain circulation is higher than to the endovascular procedures and it can be an attractive situation for choosing the second alternative to the youngest surgeons.…”