Endoscopic-assisted clipping of cerebral aneurysms.

Our experience suggests that, with current technology, it is possible to visualize, dissect, and clip cerebral aneurysm using only the endoscope for visualization. Each of the endoscopes requires little or no brain retraction and could be introduced through a bur hole. The penscope would need the largest opening (1.0 x 1.5 cm), because work is done alongside the scope. However, it overcomes the inherent problem of bur hole surgery for aneurysms: what to do in case of a rupture. Working through a slightly larger opening allows the introduction of other instruments outside of and parallel to the penscope, such as suction and aneurysm clips. The penscope is, therefore, most currently suited for aneurysm surgery.