Application of a rigid endoscope to the microsurgical management of 54 cerebral aneurysms: results in 48 patients

Object. To enhance visual confirmation of regional anatomy, endoscopy was i ntroduced during microsurgery for cerebral aneurysms. The risks and benefit s are analyzed in the present study. Methods. The endoscopic technique was used during microsurgery for 54 aneur ysms in 48 patients. Forty-three aneurysms were located in the anterior cir culation and 11 were in the posterior circulation. Thirty-eight aneurysms ( 70.4%) had not ruptured. All ruptured aneurysms in the present series produ ced Hunt and Hess Grade I or Il subarachnoid hemorrhage. After initial exposure achieved with the aid of a microscope, the rigid end oscope was introduced to confirm the regional anatomy, including the aneury sm neck and adjacent structures. The necks of 43 aneurysms were clipped usi ng microscopic control or simultaneous microscopic/endoscopic control. Afte r clipping, the positions of the clip and nearby structures were inspected using the endoscope. Use of the neuroendoscope provided useful information that further clarifie d the regional anatomy in 44 cases (81.5%) either before or after neck clip ping. In nine cases (16.7%), these details were available only with the use of the endoscope. In five cases (9.3%), the surgeons reapplied the clip on the basis of endoscopic information obtained after the initial clipping. T here were two cases in which surgical complications were possibly related t o the endoscopic procedures (one patient with asymptomatic cerebral contusi on and another with transient oculomotor palsy). Conclusions. It is the authors' impression that the use of the endoscope in the microsurgical management of cerebral aneurysms enhanced the safety and reliability of the surgery. However, there is a prerequisite for the surge on to be familiar with this instrumentation and fully prepared for the risk s and inconveniences of endoscopic procedures.