In microsurgery for aneurysms, the exposure could be very limited due to swollen brain. After clipping the aneurysm, occasionally endoscope could be used to confirm completeness of clipping or rule out inclusion of any normal blood vessel in the clip.
In Endoscope-assisted aneurysm surgery, the craniotomy, subarachnoid dissection, and cranial base osteotomy are generally performed in the usual manner. The use of the endoscope during clipping procedures includes three steps: initial inspection, clipping, and final inspection.
This 54 years old gentleman presented with brain hemorrhage. The cerebral angiography showed a large aneurysm of middle cerebral artery. The aneurysm was clipped successfully. He made uneventful recovery. We always use endoscope during these surgical procedures to confirm complete occlusion of the aneurysm and to exclude occlusion of any other blood vessel.