ORIGINAL RESEARCH article
Front. Neurol.
Sec. Endovascular and Interventional Neurology
Transcranial fully endoscopic clipping techniques for ruptured aneurysms: initial experience from a single center
Xie Zhengxing 1
Chengyang Xie 2
Yan Zhuang 1
Jieping Liu 1
1. Department of Neurosurgery,The Affiliated Hospital of Jiangsu University, Zhengjiang, China
2. Jiamusi University School of Medicine, Jiamusi, China
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Abstract
Background: Ruptured intracranial aneurysms remain a formidable challenge in neurosurgery. This study presents our initial experience with fully endoscopic bimanual clipping for ruptured aneurysms and aims to evaluate its safety and feasibility. Methods: In this retrospective single-center study, patients with ruptured aneurysms scheduled for clipping underwent surgery exclusively via fully endoscopic bimanual techniques. Data collected included patient records, radiological images, aneurysm characteristics, surgical details, and postoperative outcomes. Results: From January 2022 to April 2025, eight consecutive patients with ruptured aneurysms (2 females, 6 males; mean age 64.1±10.2 years) underwent fully endoscopic clipping. Aneurysm locations included: middle cerebral artery (n=1), posterior communicating artery (n=1), anterior communicating artery (n=3), anterior cerebral artery (n=2), and ophthalmic artery (n=1). No intraprocedural rupture occurred. Endoscopic inspection and postoperative computed tomography angiography confirmed complete aneurysm occlusion with preservation of all parent and perforating vessels in all cases. No postoperative cerebral infarction attributable to vessel compromise was observed. There was no mortality related to the endoscopic procedure. During a follow-up ranging from 1 to 28 months, seven patients (87.5%) achieved excellent or good recovery (Karnofsky Performance Status [KPS] ≥80), and one patient showed improved KPS. Conclusions: Fully endoscopic bimanual clipping for ruptured aneurysms is safe and feasible. This technique provides enhanced visual information for intraoperative decision-making while minimizing unnecessary tissue manipulation and retraction. With accumulating experience, it holds promise for further improving the quality of surgical care for ruptured aneurysms.
Summary
Keywords
aneurysm clipping, Endoscopic Surgery, fully endoscopic technique, Indoor surgery mode, Ruptured aneurysm
Received
16 September 2025
Accepted
12 February 2026
Copyright
© 2026 Zhengxing, Xie, Zhuang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Xie Zhengxing
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