title: Role of endoscopy in multi-modality monitoring during aneurysm surgery: A single center experience with 175 consecutive unruptured aneurysms.
abstract: OBJECTIVE
  Unruptured aneurysm surgery is a challenge to all vascular neurosurgeons as the patient is asymptomatic and no even slight neurological deficits should be expected postoperatively. To this aim, multi-modality checking of the vessels during the surgery is highly recommended to assure of the patency of the parent and perforator arteries next to an aneurysm. In this paper, we present our experience in the last 1.5 years with emphasis on the role of endoscope assisted microsurgery.
  
  
  METHODS
  One hundred and seventy-five patients with unruptured intracranial aneurysms were operated in our institute in the last 1½ years. All patients underwent endoscope assisted microsurgery with pre- and post-clipping indocyanine green angiography. In selected cases, motor evoked potential monitoring was implemented.
  
  
  RESULTS
  No mortality was observed in this period, and only 6 patients (3.4%) suffered new permanent neurological deficits postoperatively. Our illustrative cases show how endoscopy may help the surgeon to visualize hidden vessels behind and medial to an aneurysm.
  
  
  CONCLUSIONS
  Our results indicated that multi-modality monitoring during unruptured aneurysm surgeries is associated with excellent outcome. Endoscope is able to show blind corners during aneurysm surgery which cannot be routinely observed with microscope and its application in aneurysm surgery assists the surgeon to make certain of complete neck clipping and preservation of perforating arteries around the aneurysm.
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Ishihara
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ito
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Kaito
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Nouri
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan.
authors.forename: Motoki
authors.initials: M
authors.lastname: Oheda
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Inamasu
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hirose
keywords: Brain; clipping; endoscopy; monitoring; unruptured aneurysm