title: Simultaneous microscopic and endoscopic monitoring during surgery for internal carotid artery aneurysms.
abstract: OBJECTIVE
  The authors of this study evaluated the efficacy of simultaneous microscopic and endoscopic monitoring during surgery for internal carotid artery (ICA) aneurysms.
  
  
  METHODS
  The endoscopic technique was applied during microsurgery in 11 patients with 13 aneurysms. Nine of these lesions were located on the posterior communicating artery (PCoA), three in the paraclinoid region, and one on the anterior choroidal artery (AChA). Eight patients had unruptured aneurysms and three had ruptured aneurysms. The endoscope was introduced after first exposing the aneurysm through the microscope and was gripped firmly by an airlocked holding arm fitted with a steering system throughout the entire surgery, including dissection of the perforating arteries and application of the aneurysm clips. Regarding paraclinoid aneurysms, clips were applied through direct visualization of the ophthalmic artery and the proximal neck. In a case involving a superior hypophyseal artery aneurysm in the paraclinoid segment, a ring clip was applied without removing the bone structure around the optic canal. In all aneurysms of the PCoA and the AChA, perforating arteries behind the lesion were identified and dissected using endoscopic control. The aneurysm clip was applied in the best position in a single attempt in 10 of 11 patients. There was no surgical complication related to the endoscopic procedures.
  
  
  CONCLUSIONS
  Simultaneous monitoring with the microscope and endoscope is extremely useful in applying clips to ICA aneurysms. This combined method allows for direct dissection of the aneurysm, perforating vessels, and the main trunk in an area not visible through the microscope's eyepiece and promises better surgical results.
authors.affiliation: Department of Neurosurgery, Akita University School of Medicine, Akita, Japan. kinouchi@nsg.med.akita-u.ac.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kinouchi
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yanagisawa
authors.forename: Akira
authors.initials: A
authors.lastname: Suzuki
authors.forename: Tohru
authors.initials: T
authors.lastname: Ohta
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Hirano
authors.forename: Taku
authors.initials: T
authors.lastname: Sugawara
authors.forename: Toshio
authors.initials: T
authors.lastname: Sasajima
authors.forename: Kazuo
authors.initials: K
authors.lastname: Mizoi
mesh_terms: D000328:Adult; D000368:Aged; D002340:Carotid Artery Diseases / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008853:Microscopy; D008866:Microsurgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016343:Monitoring, Intraoperative / Q000379:methods*; D013525:Surgical Instruments