Minimally Invasive Microsurgery for Cerebral Aneurysms

摘要: Intracranial aneurysms arise in ≈2% of the population, and their rupture causes 3% all strokes.1 Their treatment requires safely achieving complete aneurysm occlusion while preserving blood flow parent, branching, perforating vessels. For decades, this task was achieved using classic open approaches, such as pterional craniotomy (PTC) described by Yasargil Fox 1975, which afforded safe effective exposure Circle Willis through Sylvian fissure with minimal retraction on frontal temporal lobes.2 Supported introduction operating microscope, approach gained popularity for treating tumors anterior circulation basilar tip.2–4 However, most significant advance has been advent endovascular techniques intracranial aneurysms, buoyed clinical trials, International Subarachnoid Aneurysm Trial5 Barrow Ruptured Trial (BRAT).6 Although both surgical technologies are appropriately selected patients, is also perceived to be less invasive compared classical surgery. Indeed, technological developments microsurgery, improved vascular imaging, intraoperative navigation, fluorescence angiography,7 have focused improving precision effectiveness. However, more recently, spurred a shift surgery minimally goal tolerability, cosmesis, acceptability patients. Ideally, should translate equivalent safety efficacy standard craniotomies, but benefit reduced operative time, postoperative pain, length in-hospital stay cosmesis.4,8 This article reviews evolution microsurgery (MIM) keyhole or mini-craniotomies development endoscope-assisted purely endoscopic These already well established …