Endoscope-Assisted Microneurosurgery for Intracranial Aneurysms: Operative Technique, Reliability, and Feasibility Based on 14 Years of Personal Experience

Endoscope-assisted microneurosurgery (EAM) combines endoscopic and microsurgical techniques for the treatment of deeply located intracranial lesions. During aneurysm surgery, endoscopic assistance may aid in the visualization of perforating arteries, especially when minimally invasive approaches are used. Between 2002 and 2015, a total of 183 patients with 208 intracranial aneurysms were surgically treated in our department. EAM was performed in 191 procedures. In all, 159 aneurysms were located in the anterior circulation and 49 in the posterior circulation. Of these, 135 aneurysms were ruptured. Lesions were exposed through standard skull base microsurgical approaches. The endoscope was employed during three steps: initial inspection, true operative time, and final inspection. Complications directly related to endoscopic procedures were rare; no surgical mortality was observed in this series. A retrospective analysis of each procedure showed that the usefulness of EAM depended on the anatomical location and size of the lesions. Its advantages were especially evident when dedicated scopes and holders were used.