# Transcranial fully endoscopic clipping techniques for ruptured aneurysms: an initial experience from a single center

## TL;DR

This paper reports on a new endoscopic surgical technique for treating ruptured brain aneurysms, showing it is safe and effective in a small group of patients.

## Contribution

The study introduces and evaluates the safety and feasibility of fully endoscopic bimanual clipping for ruptured aneurysms in clinical practice.

## Key findings

- All eight patients had complete aneurysm occlusion with no intraprocedural rupture or postoperative cerebral infarction.
- Seven out of eight patients achieved excellent or good recovery, with no mortality related to the endoscopic procedure.
- The technique provided enhanced intraoperative visualization and minimized tissue manipulation.

## Abstract

Ruptured intracranial aneurysms remain a formidable challenge in neurosurgery. This study presents our initial experience with fully endoscopic bimanual clipping for ruptured aneurysms and aims to evaluate its safety and feasibility.

In this retrospective single-center study, patients with ruptured aneurysms scheduled for clipping underwent surgery exclusively via fully endoscopic bimanual techniques. The data collected included patient records, radiological images, aneurysm characteristics, surgical details, and postoperative outcomes.

From January 2022 to April 2025, eight consecutive patients with ruptured aneurysms (two women and six men, with a mean age of 64.1 ± 10.2 years) underwent fully endoscopic clipping. Aneurysm locations included the middle cerebral artery (n = 1), posterior communicating artery (n = 1), anterior communicating artery (n = 3), anterior cerebral artery (n = 2), and ophthalmic artery (n = 1). No intraprocedural rupture occurred. Endoscopic inspection and postoperative computed tomography angiography confirmed complete aneurysm occlusion with preservation of all parent and perforating vessels in all cases. No postoperative cerebral infarctions attributable to vessel compromise were observed. No mortality related to the endoscopic procedure was observed. During follow-up ranging from 1 to 28 months, seven patients (87.5%) achieved excellent or good recovery (Karnofsky Performance Status [KPS] ≥ 80), and one patient showed improved KPS.

Fully endoscopic bimanual clipping for ruptured aneurysms is safe and feasible. This technique provides enhanced visual information for intraoperative decision-making while minimizing unnecessary tissue manipulation and retraction. Accumulating experience suggests that this technique holds promise for further improving the quality of surgical care for ruptured aneurysms.