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Open access

Can exoscope improve brain AVMs surgery?

Serena Tola, Federico Capelli, and Alessandro Della Puppa

The advantages of the surgical view provided by the exoscope have been described before, although reports of its application to brain arteriovenous malformation (AVM) surgery are lacking. The ampler field of view and magnification up to ×24 allow for enhanced visualization during microsurgical procedures. Furthermore, the live visualization provided by indocyanine green video angiography (ICG-VA) helps emphasize the hemodynamics of AVMs, even allowing the detection of possible residual vein arterialization as an indirect expression of nidal remnants. With this illustrative video showing the resection of a hemorrhagic right frontoinsular Spetzler-Martin grade III AVM, the authors describe the technical implications of exoscope brain AVM surgery using the Olympus ORBEYE 4K-3D, with a final focus on ICG-VA as an asset.

The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23114

Open access

Exoscope-assisted resection of a recurrent left frontal pilocytic astrocytoma

Sanjeev Sreenivasan, Danielle Golub, Karen Black, and Michael Schulder

An exoscope strengthens the armamentarium of a neurosurgeon by improving visualization and surgeon ergonomics, reducing surgeon discomfort, and improving coordination among the surgical team. A 23-year-old male patient developed focal seizures and weakness affecting his right arm that was attributable to a recurrent left frontal lesion. Despite two craniotomies at an 8-year interval, chemotherapy, and radiation, the tumor continued to progress. In this video, the authors demonstrate resection of a recurrent left frontal pilocytic astrocytoma with the assistance of an exoscope, neuronavigation, and neuromonitoring. The exoscope can enhance surgical resectability while smoothening the surgical workflow.

The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23158

Open access

Exoscope-assisted temporal bone resection: operative videos of the lateral and total techniques

Alejandra Rodas, Edoardo Porto, Juan M. Revuelta Barbero, Jackson R. Vuncannon, Youssef M. Zohdy, Biren Khimji Patel, Gustavo Pradilla, and C. Arturo Solares

Skull base malignancies arising from the parotid gland, skin, or external auditory canal (EAC) can potentially involve the temporal bone. Management of these invasive tumors represents a true challenge considering the critical neurovascular relationships. Exoscope-assisted temporal bone resection (TBR) plays a crucial role in addressing such malignancies. The extent of disease is evaluated using the Pittsburgh staging system, which then guides the boundaries of resection. Lateral TBR (LTBR) relies on removal of the EAC and lateral ossicles and is generally appropriate for stage T1 and T2 tumors. Total TBR (TTBR) is reserved for high-grade tumors involving the petrous apex.

The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23135

Open access

Exoscope-based supracerebellar infratentorial approach for a pineal meningioma in the prone position

Arka N. Mallela, Tritan J. Plute, Hussam Abou-Al-Shaar, David T. Fernandes Cabral, and Constantinos G. Hadjipanayis

The supracerebellar infratentorial (SCIT) approach is a well-described corridor to lesions in the quadrigeminal cistern, pineal gland, and dorsal midbrain. It can be performed in the prone or sitting position. The sitting position offers the benefit of gravity retraction of the cerebellum but comes at the expense of nonergonomic hand positioning and the potential risk of air embolism. The 3D exoscope is an alternative to the operating microscope and permits the SCIT approach in the prone position with excellent visualization. This video demonstrates exoscope-based SCIT approach for resection of a pineal meningioma in the prone position.

The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23155

Open access

Exoscope for revision of right lateral femoral cutaneous nerve decompression

Matthew C. Findlay, Spencer Twitchell, and Mark A. Mahan

The exoscope serves as a valuable addition or alternative to traditional microscope systems in surgery, offering 3D visualization and magnification with enhanced maneuverability. In lateral femoral cutaneous nerve decompression for meralgia paresthetica, the exoscope is effective in identifying strictures of neural compression and minimizing iatrogenic nerve damage that may lead to improved pain management outcomes for patients. In this report, the specific case presented showcases how the exoscope aided in surgical decompression of the lateral femoral cutaneous nerve of a patient with refractory meralgia paresthetica with remote previous decompression and resultant scarring.

The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23162

Open access

Exoscopic extradural anterior clinoidectomy

Anna Maria Auricchio, Francesco Calvanese, and Martin Lehecka

Extradural anterior clinoidectomy is a resourceful technique to decompress the optic nerve as well as increase exposure of the parasellar region during extensive approaches. Despite requiring adjunctive epidural bone work, this technique allows safe optic nerve mobilization and early devascularization for anterior clinoidal meningioma resection. This 2D operative video describes right optic nerve decompression by extradural anterior clinoidectomy and subsequent resection of a right Al-Mefty type III clinoid meningioma under exoscope magnification. The patient was a 50-year-old woman with a 1-year history of right visual acuity impairment and papillary atrophy. The exoscope allows a 360° view around the anterior clinoid, improving maneuverability.

The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23118

Open access

Exoscopic microvascular decompression for hemifacial spasm and trigeminal neuralgia

Hiroki Toda, Hirokuni Hashikata, and Ryota Ishibashi

The 4K 3D exoscope system is becoming increasingly used in neurosurgery. Its 3D ultra-high-definition image is valuable in identifying and dissecting the delicate neural and vascular structures during microvascular decompression. In this video, the authors describe several nuances and details to perform the exoscopic microvascular decompression, including the exoscope layout and the modified supine position. Several illustrative case presentations highlight the benefits of exoscopic surgery. The authors’ exoscopic microvascular decompression series of 159 patients showed noninferior surgical outcomes compared to the operative microscope with no significant increase in surgical risk. In conclusion, an exoscope can be a practical alternative to performing microvascular decompression.

The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23122

Open access

Exoscopic removal of the fourth ventricle choroid plexus papilloma with use of a midline suboccipital osteoplastic craniotomy

Rinat A. Sufianov, Ilshat A. Gaysin, Iurii A. Iakimov, and Albert A. Sufianov

Choroid plexus papillomas are relatively rare vascular tumors. In this video, the authors present a pediatric patient who underwent exoscopic removal of the fourth ventricle choroid plexus papilloma with the use of a midline suboccipital osteoplastic craniotomy. The exoscope in the fourth ventricle lesion helps to improve visualization in all directions, with the surgeon being able to maintain a comfortable position throughout the procedure. In addition, the midline suboccipital osteoplastic craniotomy helps to reduce the potential risks of complications, in particular, CSF leak and craniovertebral junction instability.

The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23106

Open access

Exoscopic resection of a parasagittal atypical meningioma

Alejandro Carrasquilla, Artur Zgurov, Mira Salih, Chi Le, Stavros Matsoukas, Rui Feng, Alexander J Schupper, and Constantinos Hadjipanayis

This video demonstrates use of the Synaptive 3D exoscope to enhance complex meningioma resection. The patient was a 58-year-old female who presented with new-onset seizures. Workup revealed a parasagittal meningioma over the bilateral cortices. She was started on 750 mg of Keppra twice daily and tapered dexamethasone and discharged. MR venography demonstrated segmental occlusion of the superior sagittal sinus. She then underwent a diagnostic angiogram and tumor Onyx embolization of the bilateral middle meningeal artery feeders. She then underwent a craniotomy for meningioma resection using 3D exoscope guidance. She awoke with a stable examination in the intensive care unit and worked with physical therapy on postoperative day 1.

The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23164

Open access

Exoscopic resection of giant olfactory groove meningioma

Francesco Calvanese, Anna Maria Auricchio, and Martin Lehecka

Olfactory groove meningiomas represent 8%–13% of all intracranial meningiomas. Gross-total resection for large (4–6 cm) and giant (> 6 cm) cases remains challenging due to their relationship with critical neurovascular structures and extensive frontal lobe edema. A variety of transcranial and endoscopic approaches have been described. This 2D operative video shows the use of a digital 3D exoscope in the removal of a giant olfactory groove meningioma through a lateral supraorbital approach in a 57-year-old woman with visual impairment and apathy. The exoscope provides a very good angulated view of the subfrontal area on both sides of the anterior cranial fossa even through a small craniotomy.

The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23125