QEVO®-Assisted Anatomical Inspection of Adjacent Perforators in Microsurgical Clipping — Technical Note
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QEVO®-Assisted Anatomical Inspection of Adjacent Perforators in Microsurgical Clipping—Technical Note
by Adi Ahmetspahic
1,2 [ORCID] , Eldin Burazerovic
1, Hana Rizvanovic
2, Ema Selimovic
2 [ORCID] , Eleonora Kujaca
2, Mirza Pojskic
3,* [ORCID] , Alberto Feletti
4 and Kenan Arnautovic
5 [ORCID]
1
Department of Neurosurgery, Clinical Center of University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
2
Department of Medicine, University Sarajevo School of Science and Technology, 71000 Sarajevo, Bosnia and Herzegovina
3
Department of Neurosurgery, Philipps University of Marburg, 35043 Marburg, Germany
4
Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, 37126 Verona, Italy
5
Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, TN 38138, USA
*
Author to whom correspondence should be addressed.
Brain Sci. 2025, 15(3), 300; https://doi.org/10.3390/brainsci15030300 [Titel anhand dieser DOI in Citavi-Projekt übernehmen]
Submission received: 27 January 2025 / Revised: 4 March 2025 / Accepted: 6 March 2025 / Published: 12 March 2025
(This article belongs to the Special Issue Current Research in Neurosurgery)
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Abstract
Introduction: 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, OberkochenTM) has been developed and employed in various neurosurgical procedures. Methods: 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. Results: 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. Conclusions: 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.
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Philipps-Universität Marburg
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Except where otherwised noted, this item's license is described as Attribution 4.0 International