Endoscopy-assisted Surgery for Cerebral Aneurysms

Abstract

The current quality of the endoscopic image displayed on the TV monitor permits beneficial and safe employment of endoscopy for access to the blind corner during aneurysm surgery under the microscope. To achieve this concept in daily surgery, the author has principally used a high-resolution rigid endoscope with an angle of vision most frequently at 70°. To facilitate this useful but hazardous endoscopy-assisted aneurysm surgery, we developed 2 surgical systems. In one, the endoscopic image is observed through the eye lenses of the microscope. This frees the neurosurgeon from the major inconvenience of having to discontinue watching the microscopic view in order to look at the endoscopic image on the video monitor. This made it possible to look at the endoscope image while observing the microscope image at the same time. In the other system, an endoscopic system was equipped with a rigid endoscope and a holder mounted on a mobile post. This facilitated rapid and easy employment of endoscopy during open surgery. The holder with flexible supporting arms had sufficient holding strength to firmly sustain the weight of an endoscope without interrupting the view under the microscope. A touch of its hand switch easily terminated the motion of the supporting arm, and the endoscope remained stable in the required position. If the switch was pressed again, the supporting arm regained free movement.
We have routinely employed microsurgical techniques assisted by the endoscopy in aneurysm surgery for more than 10 years. The maneuvers are steadily performed under simultaneous observation of the microscopic and endoscopic images. There are many advantages in combined use of an endoscope with the microscope. The obvious benefits of the endoscopy-assisted aneurysm surgery are correct clip placement on the aneurysm neck and avoidance of accidental arterial occlusion during clipping. Our increasing experience has convinced us that endoscopy-assisted microneurosurgery is essential for aneurysm surgery.