Transcranial fully endoscopic clipping techniques for ruptured aneurysms: an initial experience from a single center

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. The 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 (two women and six men, with a mean age of 64.1 ± 10.2 years) underwent fully endoscopic clipping. Aneurysm locations included the 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 infarctions attributable to vessel compromise were observed. No mortality related to the endoscopic procedure was observed. During 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. Conclusion 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. Accumulating experience suggests that this technique holds promise for further improving the quality of surgical care for ruptured aneurysms.