The Operating Microscope in Microvascular Surgery

Abstract

The operating microscope has had a profound effect on the ability of neurosurgeons to treat cerebrovascular disorders. It has allowed cerebrovascular surgery to develop in three fundamental ways. First, observations made with the microscope have made us cognizant of anatomical structures that were previously taken for granted. The complex anatomy of perforating arterial branches are now appreciated because of observations made with the operating microscope.¹³ Preservation of these branches has undoubtedly improved neurologic outcome. Second, it has enhanced our ability to perform conventional neurosurgical operations. Many operations that were performed successfully before the introduction of the microscope, e.g., aneurysmorrhaphy, are now performed with greater precision and with better clinical results. Finally, the microscope has allowed development of new procedures such as extracranial-intracranial bypass and new approaches such as the pterional entry for basilar aneurysms.¹⁷