Keyhole Approach and Neuroendoscopy for Cerebral Aneurysms

Area of Science:

• Neurosurgery
• Minimally Invasive Surgical Techniques

Background:

• Neurosurgical treatment of cerebral aneurysms has evolved with technological advancements.
• Keyhole approaches and neuroendoscopy represent significant progress in surgical armamentarium.

Purpose of the Study:

• To review the history and current status of keyhole approaches and neuroendoscopy in treating cerebral aneurysms.
• To present clinical data on the efficacy of these minimally invasive techniques.

Main Methods:

• Review of keyhole approaches (superciliary, lateral supraorbital, frontolateral, mini-pterional, mini-interhemispheric) for anterior circulation aneurysms.
• Integration of neuroendoscopy to enhance visualization and access beyond the direct line of sight.
• Application of endoscopic indocyanine green fluorescence angiography for intraoperative assessment.

Main Results:

• Keyhole approaches minimize brain exposure and retraction, creating essential surgical space.
• Neuroendoscopy expands indications for keyhole surgery by providing illumination and visualization.
• Endoscopic ICG angiography aids in detecting perforator/parent artery compromise and incomplete clipping.

Conclusions:

• Keyhole approach and neuroendoscopy are valuable intermediate steps in aneurysm treatment.
• Future advancements may lead to robotic neurosurgery, further refining minimally invasive techniques.