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Introduction Intracranial dural arteriovenous fistulae (dAVF), typically found in the dural leaflets, are vascular malformations defined by a pathological communication between meningeal arteries and dural sinus or cortical veins. Despite many of them spontaneously resolving, they are still at high risk of hemorrhage and mortality if not effectively treated and monitored. Treatment options include endovascular embolization, surgical disconnection, and radiosurgery. With the rise of endovascular treatments now widely available, there is a massive shift towards minimally invasive surgical options while it can still be argued they are not the end of open surgical repairs. Method We reviewed 12 cases each of endovascular embolization and microsurgical resection in our Neurosurgical Unit retrospectively and compare between length of hospital stay, hemorrhage, need for open surgery following endovascular technique and wound infection. Cases will be selected at random over a period of 6 months. Results We compared surgical outcomes of 12 cases each of dural AvFs that were either managed as surgical repair or endovascular embolization. In cases with associated complication, surgical repair was the preferred method although endovascular repairs had shorter length of hospital stay, lower rates of infections and rarely needed to be followed by surgical repair. Conclusions Based on the result we conclude that endovascular repairs have a shorter length of hospital stay, infections and hemorrhage, yet there are instances where surgical disconnection may be the preferred treatment method on a case-by-case basis. Endovascular treatment may not have replaced open surgical procedures just yet, but the future may hold more advances in this field.

Introduction An exoscope is a next generation HD telescope video monitoring system used to perform microsurgeries that is now a formidable rival to the existing operating microscope in neurosurgery. While the microscope revolutionised neurosurgery with its advent in 1957, the exoscope allows surgeons to operate utilising high-definition images enhancing the field of vision and focus. The exoscope opens new avenues with regards to ergonomics, teaching in theatre and enhances the surgeon’s experience. Method We will do a literature review on available literature on the use of exoscope in neurosurgery with regards to the operating microscope. Both qualitative and quantitative data will be reviewed. Personal experience of Neurosurgeons in our unit will also be reviewed using questionnaires. Results The exoscope has many benefits when compared to the operating microscope where it surpasses its predecessor in many ways. 15 studies were reviewed where the exoscope was compared to the operating microscope which concluded the exoscope equal or superior in many aspects such as teaching, ergonomics, image definition and being user friendly. There were some pitfalls of the exoscope reported such as the image being in 2D which limited the surgeon’s stereoscopic vision and the costs involved. Conclusions The exoscope is a revolutionary advent in neurosurgery and may soon make the operating microscope obsolete but there is still room for improvement.

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