Usefulness of endoscope-assisted surgery under exoscopic view in skull base surgery: A technical note

Abstract

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.

Endoscopically Assisted Exoscopic Surgery for Microvascular Decompression of the Trigeminal Nerve with Intraoperative Use of Indocyanine Green

“…Due to the anatomical variations of the NVC, there is a need for a 360 • intraoperative evaluation of the trigeminal nerve root, which can be performed using endoscopic assistance. In order to prevent incomplete decompression of the trigeminal nerve, optical devices are currently being improved, and exoscopes and endoscopes are being developed that allow surgical 360 • dissection in 3D mode with maximum magnification of anatomical structures [8]. The possibility of combined use of an exoscope and an endoscope is described by some authors, who note that this ensures safe decompression, prevents additional traction of the cerebellum, unnecessary coagulation of the superior petrosal vein (SPV), and incomplete MVD [8,9].…”

Endoscope-assisted microneurosurgery for intracranial aneurysms: A systematic review and meta-analysis

“…Especially in the past 10 years, neuroendoscopy has been rapidly popularized in clinical applications because of the improvement of endoscopic surgical instruments and surgical techniques [6][7][8]. Neuroendoscopy has a short focal length, wide field of vision, good lighting and image quality and can be used in operations such as electrocoagulation hemostasis, irrigation, and biopsy by using different channels in the endoscope [9]. In the surgical approach to deep-seated intracranial lesions, endoscopes can be used to assist microsurgical operations and control their outcome.…”