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Year : 2020  |  Volume : 15  |  Issue : 2  |  Page : 338-343

Intraoperative use of endoscope, a valuable, adjunctive tool for the surgical management of anterior communicating artery aneurysm surgery: Our institutional experience

1 Department of Neurosurgery, Krishna Institute of Medical Sciences, Karad, Maharashtra, India; Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Japan
2 Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Japan
3 Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Japan; Department of Neurosurgery, Neurosurgery Unit, AOU, Policlinico di Modena – OCSAE, Modena Hospital, Modena, Italy

Correspondence Address:
Vaibhav S Chavan
Department of Neurosurgery, Krishna Institute of Medical Sciences, Karad - 415 539, Maharashtra, India

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajns.AJNS_359_19

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Background: Anterior communicating (A-com) artery region is very complex; perforators are not always visualized on the microscope. The neuroendoscope with its higher magnification, better observation, and additional illumination can provide us information that may not be available with the microscope in aneurysm surgery. Objective: The objective was to study the use of endoscope in surgical management of A-com aneurysm surgery and its advantages, whether and how it changes operative management.Materials and Methods: We studied 25 serial cases of A-com aneurysm at Bantane Hospital, Fujita University, Japan, from November 2018 to October 2019. Once aneurysm was exposed, we did preclipping indocyanine green (ICG) study and examination with endoscope. After clipping, we again did ICG and endoscopic assessment. Preclipping and postclipping endoscopic information was used and necessary changes were made in the operative decisions. Whether endoscope gives any additional information over microscope and ICG which led to change in the operative decision was assessed. Results: In six out of 25 A-com aneurysm patients, the use of endoscope has given additional information over microscope, and ICG leading to change in the operative plans such as readjustment of the clip/application of the second clip or release of perforator compromise. Conclusion: Simultaneous endoscopic and microscopic guidance can reveal important information hidden from the microscope. Thus, this method increases the safety and durability of the A-com aneurismal clipping.

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