Cadaveric and clinical study of endoscope-assisted microneurosurgery for cerebral aneurysms using angle-type rigid endoscope

概要

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Highly advanced optical equipment enables endoscopic surgery to be performed inneurosurgery. We developed an angle-type rigid endoscope having an angled shaft, andhas performed endoscope-assisted surgery in neck clipping of 50 cerebral aneurysms.Anatomical study concerning the perforating branch was made through a pterionalapproach using 3 cadavers. By using endoscope, we can observe the posteriorcommunicating artery and anterior choroidal artery behind the internal carotid arterywithout retract the internal carotid artery and the surrounding structures.Furthermore IIIrd~VIIIth cranial nerve in opposite side and basilar artery in theposterior fossa can be observed.As the clinical study, we used endoscope in 50 clipping of cerebral aneurysms (29Internal carotid artery aneurysms, 6 anterior communicating artery aneurysms, 2anterior cerebral artery aneurysms, 7 middle cerebral artery aneurysms, 5 vertebralartery-posterior inferior cerebellar artery aneurysm, and basilar bifurcationaneurysms). The endoscopic image showed in incomplete clipping in 2 cases, whereadditional clipping was then performed. In all subject, complete clipping wasperformed using both microscopic and endoscopic view.Use of the angle-type rigid endoscope together with Doppler ultrasound, shouldincrease the feasibility of complete clipping procedure, resulting in reducedcomplication rate.
神戸大学の論文