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 ORIGINAL ARTICLE
Year : 2015  |  Volume : 63  |  Issue : 6  |  Page : 874--880

Endoscopic controlled clipping of anterior circulation aneurysms via keyhole approach: Our initial experience


Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Bhawani S Sharma
Department of Neurosurgery, All India Institute of Medical Sciences, Room No: 720, CN Centre, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.170095

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Introduction: Surgical clipping is the most definite treatment for intracranial aneurysms. Its aim is to achieve complete aneurysmal occlusion without compromising the lumen of a parent vessel or perforators, and with minimal brain tissue trauma. Objective: To evaluate the role of endoscopic controlled keyhole approach in clipping of anterior circulation aneurysms. Materials and Methods: In this retrospective study, all consecutive patients undergoing endoscopic controlled clipping via the keyhole approach by the senior author during the last 1 year were included. The cases in which a microscope was used at any stage of surgery were excluded. Results: Fourteen patients with anterior circulation aneurysms underwent clipping via the endoscopic keyhole approach (supraorbital and mini-pterional). Seven patients had anterior communicating (ACom) artery aneurysms, four had middle cerebral artery (MCA) bifurcation aneurysms, two had internal carotid artery bifurcation aneurysms, and one had a posterior communicating artery aneurysm. Ten patients presented with subarachnoid hemorrhage (Hunt and Hess grade I in 6 and grade II in 4 patients), whereas the remaining four were incidentally detected. The pre-clipping dissection as well as the clipping were successfully performed endoscopically in all patients. The post-clipping inspection revealed inclusion of a perforator within the clip blades in 2 patients (ACom and MCA bifurcation) that required clip readjustment. There was no residual neck/incompletely clipped aneurysm detected on post-clipping inspection. There was no morbidity directly attributable to the use of keyhole approach or the endoscope. Conclusion: Endoscopic keyhole approach for intracranial aneurysms combines the advantages of both keyhole approach and endoscopy. Endoscopic visualization can help to reduce chances of an incompletely clipped aneurysms/residual neck and the risk of parent vessel/perforator occlusion. However, the use of an endoscope in narrow corridors with space constraints has a learning curve that can be overcome by practicing on cadavers and initially performing several simple endoscopic procedures.






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