Abstract
We outline our initial experience with intraoperative endoscopic and sonographic monitoring for aneurysm surgery. During the last two years, endoscopic and sonographic monitoring was performed for six patients who underwent direct aneurysm clipping. We used a straight or angled rigid neuroendoscope fixed to the operative table, and observed the aneurysm and surrounding neurovascular structures during dissection and clip application. After the clip was placed, observation was done by free-hand manipulation of the endoscope. A microvascular Doppler sonography was used to document blood flow pattern in the artery near the aneurysm and in the aneurysmal neck and dome.
By endoscopic monitoring we could observe the dead-angles of the microscopic view with strong magnification and bright illumination and reduce retraction and dissection around the aneurysmal neck. We preferred the angled endoscope during clip application because it did not collide with the microscope or surgical instruments while maintaining satisfactory image quality. After the clip was properly placed, a normal blood flow pattern was noted in the parent artery and other branches, while no flow was detected inside the aneurysm. No complication due to this monitoring occurred. A combination of these two modalities could contribute to less invasive and more accurate aneurysm surgery.
