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

  • Massimo Gallieni
  • Mattia Del Maestro
  • Sabino Luzzi
  • Donatella Trovarelli
  • Alessandro Ricci
  • Renato Galzio
Conference paper
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 129)


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.


Intracranial aneurysms Sub-arachnoid hemorrhage Clip ligation Microneurosurgery Endoscope-assisted microsurgery 


Conflict of Interest Statement

The authors declare that they have no conflict of interest.


  1. 1.
    Apuzzo ML, Heifetz MD, Weiss MH, Kurze T. Neurosurgical endoscopy using the side-viewing telescope. J Neurosurg. 1977;46(3):398–400.CrossRefGoogle Scholar
  2. 2.
    Halves E, Bushe KA. Transsphenoidal operation on craniopharyngiomas with extrasellar extensions. The advantage of the operating endoscope [proceedings]. Acta Neurochir Suppl. 1979;28(2):362.PubMedGoogle Scholar
  3. 3.
    Matula C, Tschabitscher M, Day JD, Reinprecht A, Koos WT. Endoscopically assisted microneurosurgery. Acta Neurochir. 1995;134(3–4):190–5.CrossRefGoogle Scholar
  4. 4.
    Perneczky A, Fries G. Endoscope-assisted brain surgery: part 1—evolution, basic concept, and current technique. Neurosurgery. 1998;42(2):219–24.CrossRefGoogle Scholar
  5. 5.
    Kim Y, Yoo C-J, Park CW, Kim MJ, Choi DH, Kim YJ, Park K. Modified supraorbital keyhole approach to anterior circulation aneurysms. J Cerebrovasc Endovasc Neurosurg. 2016;18(1):5–11.CrossRefGoogle Scholar
  6. 6.
    Ormond DR, Hadjipanayis CG. The supraorbital keyhole craniotomy through an eyebrow incision: its origins and evolution. Minim Invasive Surg. 2013;2013:296469.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Reisch R, Perneczky A, Filippi R. Surgical technique of the supraorbital key-hole craniotomy. Surg Neurol. 2003;59(3):223–7.CrossRefGoogle Scholar
  8. 8.
    Fries G, Perneczky A. Endoscope-assisted brain surgery: part 2—analysis of 380 procedures. Neurosurgery. 1998;42(2):226–31.CrossRefGoogle Scholar
  9. 9.
    Fischer G, Oertel J, Perneczky A. Endoscopy in aneurysm surgery. Neurosurgery. 2012;70(2 Suppl Operative):184–90.PubMedGoogle Scholar
  10. 10.
    Perneczky A, Boecher-Schwarz HG. Endoscope-assisted microsurgery for cerebral aneurysms. Neurol Med Chir. 1998;38(Suppl):33–4.CrossRefGoogle Scholar
  11. 11.
    Fischer J, Mustafa H. Endoscopic-guided clipping of cerebral aneurysms. Br J Neurosurg. 1994;8(5):559–65.CrossRefGoogle Scholar
  12. 12.
    Kalavakonda C, Sekhar LN, Ramachandran P, Hechl P. Endoscope-assisted microsurgery for intracranial aneurysms. Neurosurgery. 2002;51(5):1119–26.CrossRefGoogle Scholar
  13. 13.
    Kato Y, Sano H, Nagahisa S, Iwata S, Yoshida K, Yamamoto K, Kanno T. Endoscope-assisted microsurgery for cerebral aneurysms. Minim Invasive Neurosurg. 2000;43(2):91–7.CrossRefGoogle Scholar
  14. 14.
    Taniguchi M, Takimoto H, Yoshimine T, Shimada N, Miyao Y, Hirata M, Maruno M, Kato A, Kohmura E, Hayakawa T. Application of a rigid endoscope to the microsurgical management of 54 cerebral aneurysms: results in 48 patients. J Neurosurg. 1999;91(2):231–7.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Massimo Gallieni
    • 1
  • Mattia Del Maestro
    • 1
  • Sabino Luzzi
    • 2
  • Donatella Trovarelli
    • 3
  • Alessandro Ricci
    • 2
  • Renato Galzio
    • 1
    • 2
  1. 1.Department of Life, Health and Environmental Sciences (MESVA)University of L’AquilaL’AquilaItaly
  2. 2.Department of NeurosurgerySan Salvatore City HospitalL’AquilaItaly
  3. 3.Department of AnesthesiologySan Salvatore City HospitalL’AquilaItaly

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