Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria.
Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany.
World Neurosurg. 2023 Feb;170:e200-e213. doi: 10.1016/j.wneu.2022.10.106. Epub 2022 Nov 9.
The literature on exoscope use in cerebrovascular neurosurgery is scarce, mainly comprising small case series and focused on visualization quality and ergonomics. As these devices become widely used, direct comparison to the operating microscope regarding efficacy and patient safety is necessary.
Fifty-two consecutive clipping procedures, performed by 1 senior vascular neurosurgeon, were analyzed. Either an operating microscope with a mouth switch (25 cases with 27 aneurysms; 13 ruptured) or a three-dimensional exoscope with a foot switch (27 cases with 34 aneurysms; 6 ruptured) were used. Durations of major surgical stages, number of device adjustments, numbers of clip repositionings and clips implanted were extracted from surgical videos. Demographic data, imaging characteristics, clinical course and outcomes were extracted from digital patient records.
Duration of surgery and different stages did not differ between devices, except for final site inspection. The number of device adjustments was higher with the exoscope. With progressive experience in exoscope use, the number of device adjustments increased significantly, whereas surgery duration remained unchanged. Favorable outcome (modified Rankin Scale score 0-2) was observed in 80% and 88% of patients in the microscope and exoscope groups, respectively. Ischemic events were found in 2 patients in each group; no other complications occurred.
In aneurysm clipping, three-dimensional exoscopes are noninferior to operating microscopes in terms of surgery duration, safety, and outcomes, based on our limited series. Progressive experience enables the surgeon to perform significantly more device adjustments within the same amount of surgical time.
外骨骼在脑血管神经外科中的应用文献很少，主要包括小病例系列，重点关注可视化质量和人体工程学。随着这些设备的广泛应用，有必要将其与手术显微镜在疗效和患者安全性方面进行直接比较。
分析了由 1 名资深血管神经外科医生进行的 52 例连续夹闭手术。使用手术显微镜配口动开关（25 例，27 个动脉瘤；13 个破裂）或三维外骨骼配脚踏开关（27 例，34 个动脉瘤；6 个破裂）。从手术视频中提取主要手术阶段的持续时间、设备调整次数、夹重新定位次数和夹植入数量。从数字患者记录中提取人口统计学数据、影像学特征、临床过程和结果。
除最终检查部位外，手术时间和不同阶段在两种设备之间没有差异。外骨骼的设备调整次数更高。随着外骨骼使用经验的逐步增加，设备调整次数显著增加，而手术时间保持不变。显微镜组和外骨骼组的患者预后良好（改良 Rankin 量表评分 0-2）分别为 80%和 88%。两组各有 2 例患者出现缺血事件；无其他并发症发生。
在动脉瘤夹闭中，根据我们的有限系列，三维外骨骼在手术时间、安全性和结果方面与手术显微镜相比不劣。经验的逐步积累使外科医生能够在相同的手术时间内进行更多的设备调整。
