Clipping of anterior circulation aneurysms using fully endoscopic-assisted minimally invasive keyhole craniotomy: a clinical study and analysis

Endoscopy's ability to provide close observation, deep magnification, and multi-angle views has proven to be an effective tool for minimally invasive craniotomy in neurosurgery. However, no large case series have been published on the use of fully endoscopic-assisted minimally invasive keyhole craniotomy for clipping intracranial aneurysms (IAs). To evaluate the value of fully endoscopic-assisted minimally invasive keyhole craniotomy in the treatment of anterior circulation aneurysms. A retrospective analysis was conducted on 20 patients who underwent fully endoscopic-assisted minimally keyhole invasive craniotomy for clipping of IAs. A total of 9 anterior communicating artery (ACoA) aneurysms were clipped using the supraorbital keyhole approach (SKA). Additionally, 10 middle cerebral artery aneurysms (MCA) and 2 posterior communicating artery (PCoA) aneurysms were clipped using the pterional keyhole approach (PKA). The clipping success rate was 100% in all patients. Apart from one patient who experienced transient third cranial nerve palsy, one who developed an intracranial infection, and one who had a brief seizure, no other patients experienced serious complications. Except for one patient who had residual muscle weakness due to a preoperative basal ganglia hemorrhage, all other patients had a modified Rankin Scale (mRS) score of ≤ 1. Fully endoscopic-assisted minimally invasive keyhole craniotomy has promising applications in the treatment of anterior circulation aneurysms in Hunt-Hess grade 0-II, especially for unruptured aneurysms. Future multi-center studies are needed to confirm its broader applicability.