Diagnostic optics for endoscopically assisted microneurosurgery
In addition to neurosurgical operations on the brain, which are carried out exclusively under endoscopic control (endoscopic microneurosurgery), endoscopes have proven themselves in microsurgical procedures (endoscopically assisted microsurgery). If with direct observation through a microscope, it is impossible to review the entire preparation process, or brain structures (vessels, nerves) are located in front of the target point that prevents direct vision, then the hidden zones can be examined using an endoscope, bypassing these structures. This way you can avoid lengthy craniotomies and extensive preparatory steps in brain surgery.
For endoscopically assisted microsurgery, HOPKINS rigid telescopes with high aperture, high resolution, and wide aperture angle are particularly suitable. In order not to interfere with microsurgical preparation, these telescopes are equipped with an angled eyepiece and attach to an autostatic bracket system ("holder"). So the neurosurgeon can operate with two hands in a straight line parallel to the endoscope. The use of endoscopes especially helps in operations on the base of the skull in the subarachnoid space. During operations of the auditory nerve neuroma, it makes sense, for example, to look "around the corner" of the internal auditory canal and remove the remnants of the tumor on its lower inner part. When clipping an aneurysm, you can look behind the aneurysm and artery to assess the accuracy of the brace placement and avoid narrowing of the blood vessels supplying the brain or incomplete clipping of the aneurysm. In transphenoidal pituitary surgery, an endoscope is indispensable.