Ahmetspahic Adi, Burazerovic Eldin, Rizvanovic Hana, Selimovic Ema, Kujaca Eleonora, Pojskic Mirza, Feletti Alberto, Arnautovic Kenan
Department of Neurosurgery, Clinical Center of University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina.
Department of Medicine, University Sarajevo School of Science and Technology, 71000 Sarajevo, Bosnia and Herzegovina.
Brain Sci. 2025 Mar 12;15(3):300. doi: 10.3390/brainsci15030300.
Aneurysms of brain vessels are life-threatening conditions with various adverse outcomes, some stemming from microsurgical intervention, particularly when major vessel perforators are inadequately protected. The use of endoscopes enhances the approach to aneurysms by providing closer visualization (180-360 degrees) of the local anatomy, potentially reducing accidental damage. To improve visualization and efficiency, a microscope-integrated 45-degree angled microinspection endoscopic tool (QEVO, Carl Zeiss, Oberkochen) has been developed and employed in various neurosurgical procedures.
Between 2021 and 2025, 27 brain aneurysms were treated with QEVO assistance at the Department of Neurosurgery, Clinical Center of the University of Sarajevo. The choice of the videos corresponds to the best image quality in videos and on the microscopic determination of adjacent vessel perforators, which were not adequately seen purely by the surgical microscope in specific cases. Exclusion criteria included cases without a need for QEVO assistance in perforator visualization, severe brain edema, intraoperative aneurysm rupture, posterior circulation, or low video quality.
Case 1 demonstrates an anterior choroidal artery (AchA) aneurysm; Case 2 presents an anterior communicating artery (AcommA) aneurysm; and Case 3 features contralateral middle cerebral artery (MCA) microsurgical clipping with QEVO assistance.
The QEVO tool significantly improves the visualization of aneurysm-perforator relationships, increasing the likelihood of preserving perforators during standard microsurgical clipping. This innovative approach may reduce surgical complications and enhance patient outcomes, highlighting the tool's potential as an adjunct in aneurysm microsurgery.
脑血管动脉瘤是危及生命的疾病，会导致各种不良后果，其中一些源于显微手术干预，尤其是在主要血管穿支未得到充分保护时。内窥镜的使用通过提供更近距离（180 - 360度）的局部解剖结构可视化，增强了对动脉瘤的手术入路，有可能减少意外损伤。为了提高可视化程度和效率，已开发出一种集成在显微镜上的45度角显微检查内窥镜工具（QEVO，卡尔·蔡司公司，奥伯科亨）并应用于各种神经外科手术中。
2021年至2025年期间，萨拉热窝大学临床中心神经外科使用QEVO辅助治疗了27例脑动脉瘤。视频的选择对应于视频中最佳图像质量以及在显微镜下对相邻血管穿支的判定，在特定情况下，仅通过手术显微镜无法充分看清这些穿支。排除标准包括在穿支可视化方面无需QEVO辅助的病例、严重脑水肿、术中动脉瘤破裂、后循环或视频质量差的病例。
病例1展示了脉络膜前动脉（AchA）动脉瘤；病例2展示了前交通动脉（AcommA）动脉瘤；病例3展示了在QEVO辅助下对大脑中动脉（MCA）对侧进行显微夹闭。
QEVO工具显著改善了动脉瘤与穿支关系的可视化，增加了在标准显微夹闭过程中保留穿支的可能性。这种创新方法可能会减少手术并发症并改善患者预后，凸显了该工具作为动脉瘤显微手术辅助工具的潜力。
