Ricciardi Luca, Chaichana Kaisorn L, Cardia Andrea, Stifano Vito, Rossini Zefferino, Olivi Alessandro, Sturiale Carmelo Lucio
Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy; Departmentof Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Neurosurgery, Mayo Clinic College of Medicine, Jacksonville, Florida, USA.
Departmentof Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy.
World Neurosurg. 2019 Apr;124:136-144. doi: 10.1016/j.wneu.2018.12.202. Epub 2019 Jan 17.
The introduction of operative microscopes (OMs) is the most important revolution in modern microneurosurgery, as a result of the implementation of lighting and magnification of the surgical field and of the capability to dissect the microneurovascular structures. Recently, the advent of video telescopic intraoperative microscopes or exoscopes (EX) has enlarged these perspectives in neurosurgery.
To systematically review all the pertinent literature.
We systematically reviewed the pertinent literature and collected all the reported experience with EX use in neurosurgery. Quantitative and qualitative data, along with the authors' opinions and concerns, were recorded and analyzed. A comparison with the OM was also considered.
Twenty-nine studies reporting surgical procedures on 574 patients were included in the study. Data analysis was categorized in 3 groups, representing technical, surgical, and educational aspects. The EX is largely considered superior or equivalent to OM in many features, such as the surgeon's ergonomic comfort, educational opportunities, image quality, magnification, lighting, and costs. However, some surgeons still prefer the OM, especially for its better stereoscopic vision.
The EX has been emerging as an alternative to the OM for performing many cranial, spinal, and peripheral neurosurgical procedures. Despite some limitations, this new optical device presents many features that can be considered as an evolution of the OM. In future years, larger studies will confirm these preliminary impressions.
手术显微镜（OM）的引入是现代显微神经外科领域最重要的变革，它实现了手术视野的照明和放大，以及对显微神经血管结构进行解剖的能力。最近，视频伸缩式术中显微镜或外视镜（EX）的出现拓宽了神经外科的视野。
系统回顾所有相关文献。
我们系统回顾了相关文献，并收集了所有已报道的在神经外科使用EX的经验。记录并分析了定量和定性数据，以及作者的观点和担忧。还对与OM进行了比较。
该研究纳入了29项报告了对574例患者进行手术操作的研究。数据分析分为3组，分别代表技术、手术和教育方面。在许多方面，EX在很大程度上被认为优于或等同于OM，如外科医生的人体工程学舒适度、教育机会、图像质量、放大倍数、照明和成本。然而，一些外科医生仍然更喜欢OM，特别是因其具有更好的立体视觉。
EX已逐渐成为在许多颅脑、脊柱和周围神经外科手术中替代OM的选择。尽管存在一些局限性，但这种新型光学设备具有许多可被视为OM的改进之处的特征。在未来几年，更大规模的研究将证实这些初步印象。
