Kết quả bước đầu phẫu thuật nội soi toàn bộ xuyên sọ kẹp cổ túi phình tuần hoàn trước

Abstract

Fully endoscopic transcranial clipping (FETC) is a novel approach employing the endoscope as the sole visualizing instrument, aiming to preserve perforating arteries and achieve complete aneurysm obliteration through a small craniotomy. We conducted an ambispective descriptive study of 58 patients with anterior circulation aneurysms who underwent FETC at Bach Mai Hospital (November 2025–May 2026), assessing feasibility, safety, and the quality of endoscopic visualization. Mean age was 59.4 ± 9.3 years old; 51.7%  had anterior communicating artery aneurysms and 34.5% had middle cerebral artery aneurysms; 39.7% were ruptured. Surgical field clarity was rated good in 93.1%, and clip readjustment after endoscopic inspection occurred in 26.3%. Complete occlusion was achieved in 94.8%, with no brain retraction in 89.7%. Intraoperative rupture occurred in 17.2%, was concentrated in the previously ruptured group, and was controlled in all cases. At discharge, 100% achieved mRS 0–2, with no in-hospital mortality. The technique is feasible and safe in this initial experience; high-quality endoscopic visualization enable optimization of clip placement in a substantial number of cases. However, extended follow-up and controlled comparison are needed to confirm its value.