Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
World Neurosurg. 2024 Apr;184:e1-e8. doi: 10.1016/j.wneu.2024.01.136. Epub 2024 Feb 1.
Digital 3D exoscopes have been shown to be comparably safe and effective as surgical microscopes in complex microneurosurgical procedures. However, the results of exoscopic spinal tumor surgeries are scarce. The purpose of this study is to compare results of a transition from microscope to exoscope in surgeries for spinal intradural extramedullary tumors.
We included all consecutive patients with intradural extramedullary spinal tumors operated on by the senior author during January 2016 to October 2023. The 3D exoscope was used in the latter half of the series from November 2020. We evaluated pre- and postoperative clinical findings, imaging studies, intra- and postoperative events, and analyzed surgical videos from the operations retrospectively.
We operated 35 patients (exoscope n = 19, microscope n = 16) for intradural extramedullary tumors (meningioma n = 18, schwannoma n = 12, other n = 5). Tumors in the cervical and thoracic spine were more common than in the lumbar region. The duration of surgery was slightly longer (median 220 vs. 185 minutes) in the exoscope group. However, the rate of gross total resection of the tumor was higher (81% vs. 67%) and the tumors more often located anteriorly to the spinal cord (42% vs. 13%) in the exoscope group. No major complications (i.e., permanent motor deficit or postoperative hematoma) occurred in either group. We saw postoperative gait improvement in 81% and 85% of the patients with preoperative deterioration of gait after exoscopic and microscopic surgeries, respectively.
This study demonstrates that exoscope-assisted surgery for spinal intradural extramedullary tumors is comparable in safety and effectiveness to traditional microscopic surgery.
数字 3D 外窥镜已被证明在复杂的微创神经外科手术中与手术显微镜一样安全有效。然而，外窥镜脊柱肿瘤手术的结果却很少。本研究的目的是比较显微镜过渡到外窥镜在脊柱髓外硬脊膜内肿瘤手术中的结果。
我们纳入了所有由资深作者在 2016 年 1 月至 2023 年 10 月期间连续手术治疗的脊髓髓外硬脊膜内肿瘤患者。3D 外窥镜在 2020 年 11 月开始使用。我们评估了患者术前和术后的临床发现、影像学研究、术中及术后事件，并回顾性地分析了手术视频。
我们对 35 例（外窥镜 n=19，显微镜 n=16）脊髓髓外硬脊膜内肿瘤（脑膜瘤 n=18，神经鞘瘤 n=12，其他 n=5）患者进行了手术。颈椎和胸椎的肿瘤比腰椎更常见。外窥镜组的手术时间略长（中位数 220 分钟 vs. 185 分钟）。然而，肿瘤全切除率更高（81% vs. 67%），肿瘤更常位于脊髓前方（42% vs. 13%）。两组均无严重并发症（即永久性运动障碍或术后血肿）。在外窥镜和显微镜手术后，术前步态恶化的患者中分别有 81%和 85%的患者术后步态得到改善。
本研究表明，外窥镜辅助脊柱髓外硬脊膜内肿瘤手术在安全性和有效性方面与传统显微镜手术相当。
