Document Detail

Endoscope-assisted microsurgery for intracranial aneurysms.
MedLine Citation:
PMID:  12383356     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: We discuss the role of the endoscope in the microsurgical treatment of intracranial aneurysms, analyzing its benefits, risks, and disadvantages. METHODS: This was a prospective study of 55 patients with 79 aneurysms, treated between July 1998 and June 2001, for whom the endoscope was used as an adjunct in the microsurgical treatment of their lesions. Seventy-one aneurysms were located in the anterior circulation, and eight were located in the posterior circulation. Thirty-seven patients presented with subarachnoid hemorrhage. Eighteen patients had unruptured aneurysms, of whom 5 presented with mass effect, 2 presented with transient ischemic attacks, and 11 were without symptoms. In all cases, the endoscope was used in addition to microsurgical dissection and clipping (sometimes before clipping, sometimes during clipping, and always after clipping), for observation of the neck anatomic features and perforators and verification of the optimal clip position. Intraoperative angiography was performed for all patients after aneurysm clipping. RESULTS: In the majority of cases, the endoscope was very useful for the assessment of regional anatomic features. It allowed better observation of anatomic features, compared with the microscope, for 26 aneurysms; in 15 cases, pertinent anatomic information could be obtained only with the endoscope. The duration of temporary clipping of the parent artery was significantly reduced for two patients. The clip was repositioned because of a residual neck or inclusion of the parent vessel during aneurysm clipping in six cases, and the clip position was readjusted because of compression of the optic nerve in one case. One patient experienced a small aneurysm rupture that was directly related to use of the endoscope, but this was easily controlled, with no sequelae. For many patients, the combination of the neuro-endoscope and the micro-Doppler probe made intraoperative angiography redundant. CONCLUSION: "Endoscope-assisted microsurgery" is a major advance in the microsurgical treatment of intracranial aneurysms; the endoscope allows better observation of regional anatomic features because of its magnification, illumination, and ability to "look around corners."
Chandrasekar Kalavakonda; Laligam N Sekhar; Pranatartiharan Ramachandran; Peter Hechl
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurosurgery     Volume:  51     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  2002 Nov 
Date Detail:
Created Date:  2002-10-17     Completed Date:  2002-12-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1119-26; discussion 1126-7     Citation Subset:  IM    
Mid-Atlantic Brain and Spine Institutes, 3301 Woodburn Road, Annandale, VA 22003, USA.
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MeSH Terms
Cerebral Angiography
Intracranial Aneurysm / radiography,  surgery*
Microsurgery* / adverse effects
Middle Aged
Neurosurgical Procedures* / adverse effects
Prospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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