Endoscope-assisted keyhole approach in cerebral aneurysm surgery

Abstract

The last decades in neurosurgery have been marked by the rapid development of minimally invasive techniques, including the use of the concept of keyhole/burrhole surgery and active introduction of endoscopic techniques. These alternatives to traditional approaches have minimized concomitant injury to tissues and the brain and improved functional and cosmetic outcomes. Endoscopic assistance in keyhole approaches, along with its use in traditional approaches, seems even more reasonable because the field of microscopic view is considerably limited in the case of a mini-approach. Aim - we present our experience of using endoscopic assistance (EA) in aneurysm surgery through supraorbital and transorbital keyhole approaches. Material and methods. We describe the surgical technique, indications for EA, and possible complications. In the period between 2014 and 2107, we used EA in the surgical treatment of 40 patients with cerebral aneurysms of the internal carotid (37 patients) and basilar (3) arteries. In all cases, 0 and 30° rigid endoscopes were used. The EA technique involved standard stages: assessment of anatomy before clipping and assessment after clipping. In 5 (12.5%) patients, clipping was performed under endoscopic visualization. The follow-up period was 6―12 months, on average. Results. All patients underwent successful clipping of aneurysms without neurological complications. There was no death, disability, or serious permanent approach-associated complications in the study group. Conclusion. EA is a safe and effective technique providing additional visualization in keyhole surgery of aneurysms.