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Moreover, the microscope provides the surgeon with control of the whole surgical field, compared to only distal (at the endoscope tip) control afforded by the endoscope. Integration of the endoscope and microscope (endoscopic-assisted microneurosurgery) could result in combined advantages. Indeed, the endoscope could expose and visualize structures that are inadequately exposed or not exposed at all due to the straight line of view obtained by the microscope. Consequently, we reasoned that we could preserve the proven advantages of microscopic neurosurgical techniques while the introduction of the endoscope could provide additional visualization of the surgical field, which is limited by the narrow TGF-beta inhibitor corridor in the microscopic view due to the deep location of the BA. Our results show that, in our model, endoscopic assisted microsurgery is associated with a wider working area than microsurgery alone. Indeed we showed that using 0�� and 30�� endoscopes via a PT craniotomy we achieved better exposure that using the microscope via an OZ craniotomy (217.4 �� 54 mm2, 251.4 �� 68.8 mm2 and 160 �� 34.3 mm2? respectively). This difference was statistically significant (P Resminostat Dorsomorphin molecular weight Navigation pointer on the basilar artery (BA) tip, visualized with an endoscope. A large segment of the BA trunk is visible. (BA-basilar artery, SCA-superior cerebellar artery, P1-P1 segment of posterior cerebral artery, PCOM-posterior ... Figure 7 Pterional approach. Navigation pointer on the mid basilar artery. Bifurcation nicely visible Figure 6 Pterional approach. Manipulation (aneurismal clip placement) over the basilar artery trunk which can be exposed only by endoscope. The arrow is indicating the basilar tip Likewise, one must be cogniscent that, with the present status of technical development, it is very arduous to operate on structures visualized with the angled endoscopes. Visualization does not necessarily mean safe operability. Moreover, by integrating the microscope and the endoscope the surgeon is able to continuously utilize and integrate the information garnered through one or the other tool, thereby optimizing the end result. Indeed the 3-D perception associated with the microscope may be transmitted to the endoscopic part of the operation and the endoscopic ability to look around the corner may be transferred to the microscope part of the operation. Clearly, the ability to look around the corners and to know where vascular structures are located is crucial when operating on BA vascular lesions.
