gms | German Medical Science

Objective: Surgical clipping remains the most definitive treatment for intracranial aneurysms. The value of endoscopic application during microsurgical procedures is evaluated in a retrospective study.

Methods: One-hundred-eighty aneurysms were microsurgically treated in 124 operations. Three different applications of endoscopic visualization were employed depending on the respective requirements: inspection prior to clipping, clipping under endoscopic view and post-clipping evaluation.

Results: Out of 1380 aneurysms, 292 procedures were done with application of the endoscope. Out of these, a complete data set including video recording of the procedures was available in 180 cases for retrospective evaluation. In these, the endoscope provided a favorable enhancement of the visual field particularly in complex or deeply situated lesions. No adverse effects were observed. Prior to clipping the endoscope was used to gain additional topographic information in 150 of 180 cases (83%). Clipping under endoscopic control was performed in four cases. After clipping, endoscopic inspection was performed in 130 of 180 procedures. Depending on the endoscopic findings, rearrangement of the applied clip or additional clipping was found necessary in 26 of 130 cases (20.0%).

Conclusions: The additional endoscopic enhancement of the visual field provided by the endoscope before, during and after microsurgical aneurysm occlusion may be a safe and effective application to increase the quality of treatment. Although unexpected findings concerning completeness of aneurysm occlusion and compromise of involved vessels could be diminished by endoscopic assessment, a total prevention was not accomplished.