Principles and Ergonomics of Direct Aneurysm Surgery

With the operating microscope, in the 1960s came a powerful, unobstructed light source and magnified anatomy. Shortly following this development, delicate and fine dissectors, forceps and scissors became available. Aneurysm clips were gradually modified to accommodate and make best use of this new technology. Direct microsurgical clipping by craniotomy has become the most commonly applied procedure for managing an intracranial aneurysm and is currently available to virtually every aneurysm surgeon. Because of the many variations in aneurysm size, shape, and location, and peculiarities in anatomy of accompanying vessels, each operation must remain highly individualized. This chapter describes those procedures that must be used to achieve a successful outcome in a patient harboring an intracranial aneurysm and the auxiliary therapy required to accomplish this to its best advantage.