Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar.
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
World Neurosurg. 2022 Feb;158:e231-e236. doi: 10.1016/j.wneu.2021.10.165. Epub 2021 Oct 30.
The use of an exoscope in neurosurgical procedures has been proposed to improve ergonomics and to overcome the limitations faced with the microscope and endoscope. However, there remains scarcity of data regarding its surgical utility and outcomes. The authors report their experience and evaluate the surgical outcomes using a high-definition 2-dimensional (HD-2D) stereotactic exoscope in the management of various cranial and spinal pathologies.
We retrospectively identified patients who underwent neurosurgical procedures using the HD-2D stereotactic exoscope over a 2-year period. Demographic and surgical characteristics were analyzed.
Twenty-nine patients (70.7%) underwent cranial surgery, and 12 patients (29.3%) underwent spine surgery. In patients having brain tumor removal, gross total resection was achieved in 18 patients (62.1%), with an overall average pathology size of 4.2 ± 1.6 cm. Adjuvant utilization of the microscope was required in 4 cranial cases (13.8%) to ensure optimal resection rate. Three complications and 2 mortalities were encountered in the cranial group during a mean follow-up of 4.6 ± 3.3 months. In the spinal cohort, the HD-2D stereotactic exoscope was used for anterior decompression and fusion (n = 5), posterior decompression and fusion (n = 5), and microdiskectomy and foraminotomy (n = 2). No complications were encountered in the spinal group during a mean follow-up of 3.8 ± 2.7 months.
The HD-2D stereotactic exoscope offers a wider field of view, greater mean focal distance, enhanced ergonomics, and immersive stereotactic visual experience. The lack of stereopsis remains the principal limitation of its use, and further optimization of surgical outcomes might be achieved with newer 3-dimensional models.
在神经外科手术中使用手术显微镜外窥镜可以改善手术的舒适度，并克服显微镜和内窥镜带来的局限性。然而，关于其手术实用性和结果的数据仍然很少。作者报告了他们的经验，并评估了在管理各种颅颈和脊柱病变时使用高清 2 维（HD-2D）立体定向手术显微镜外窥镜的手术结果。
我们回顾性地确定了在 2 年内接受 HD-2D 立体定向手术显微镜外窥镜治疗的患者。分析了患者的人口统计学和手术特征。
29 例患者（70.7%）接受了颅部手术，12 例患者（29.3%）接受了脊柱手术。在接受脑肿瘤切除的患者中，18 例（62.1%）实现了大体全切除，总体平均病理大小为 4.2 ± 1.6cm。为了确保最佳切除率，4 例（13.8%）颅部手术需要辅助使用显微镜。在平均 4.6 ± 3.3 个月的随访期间，颅部组有 3 例并发症和 2 例死亡。在脊柱组中，使用 HD-2D 立体定向手术显微镜外窥镜进行了前路减压和融合（n=5）、后路减压和融合（n=5）、显微椎间盘切除术和椎间孔切开术（n=2）。在平均 3.8 ± 2.7 个月的随访期间，脊柱组未发生任何并发症。
HD-2D 立体定向手术显微镜外窥镜提供了更宽的视野、更大的平均焦距、增强的操作舒适性和身临其境的立体视觉体验。缺乏立体视觉仍然是其使用的主要限制，使用更新的 3 维模型可能会进一步优化手术结果。
