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Background: The use of the exoscope has been increasing in the field of neurosurgery, as it can set the visual axis freely, enabling the surgeon to operate in a comfortable posture. Although endoscope-assisted surgery for compensation of insufficient surgical field is useful under the microscope, we report that using an endoscope in exoscopic surgery is safer and more useful. Methods: The exoscope used was ORBEYE. All surgical procedures were performed exoscopically from the beginning of the surgery. When endoscopic observation was required during the operation, the endoscope was inserted under observation by an exoscope. The exoscopic screen was 4K-3D and endoscopic screen was 4K-2D, the operation was performed while observing both screens at the same time. The endoscope was held manually or by a mechanical holder. Results: Twenty-two cases, including 14 requiring microvascular decompression (MVD) and eight requiring tumor removal, were performed by endoscopic-assisted exoscopic surgery. The endoscope could be inserted safely because its relationship with the surrounding structure could be observed under the exoscope, and the operator could observe both screens without moving the head. Fourteen of 22 patients required additional endoscopic treatment. Satisfactory two-handed operation was performed in 13 cases. Symptomatology disappeared in all cases of MVD, and sufficient tumor resection was achieved. Conclusion: Exoscopic surgery provides excellent surgical view that is not inferior to conventional microsurgery. As a large space can be secured between the scope and the surgical field, it is safer and easier to manipulate the endoscope under the exoscope.

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Objective: We treated a patient with carotid artery stenosis complicating scleroderma by carotid artery stenting (CAS) and achieved satisfactory dilation. Since scleroderma was suspected to have induced carotid artery stenosis, we report the case with a review of the literature. Case Presentation:The patient was a 75-year-old woman diagnosed with scleroderma 8 years before. She thereafter developed polymyositis, liver cirrhosis, and stenosis of the bilateral internal carotid arteries; as progression of stenosis was observed, treatment was considered necessary. In consideration of the patient's general condition, CAS by the transbrachial approach was selected. There was no complication associated with the procedure, and satisfactory dilation could be achieved. No restenosis was observed 6 months after the procedure. The history of previous disorders and the results of antibody tests strongly suggested scleroderma as a cause of carotid artery stenosis. Conclusion:We performed CAS in a patient with carotid artery stenosis suspected to have been caused by scleroderma and obtained a favorable outcome.

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