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Owing to recent advances in medical optical technology, a high-definition (4K) three-dimensional (3D) exoscope has been developed as an alternative tool to using conventional microscopes for microscopic surgery, and its efficacy for neurosurgery has been reported. We report a case who underwent simultaneous surgery aiming for en bloc resection of an anterior skull base malignancy with concurrent exoscopic transcranial and endoscopic endonasal approaches using a 4K 3D exoscope. The patient was a 76-year-old woman who underwent en bloc resection for an anterior skull base olfactory neuroblastoma 13 years ago. After confirming the recurrence of progressive olfactory neuroblastoma, tumor resection was again decided to be performed. As with the first procedure, surgery was performed in an en bloc manner, using both transcranial and endonasal approaches. Exoscope provided enough space above the surgical field to allow us to perform transcranial and endonasal surgeries simultaneously. Moreover, the surgeons could maintain a comfortable posture throughout the procedure, and total tumor removal was successfully achieved without any abnormal event. To our knowledge, this is the first report of the introduction of an exoscope aiming for en bloc resection of an anterior skull base malignancy while performing simultaneous surgery with both transcranial and endonasal approaches. We believe that the more cases are accumulated, the more efficacy of a 4K 3D exoscope will be elucidated.

Medulloblastoma is the most common pediatric malignant tumor and about 84.2% of cases are under 15 years old. With a current combined-modality approach that includes surgical approach, chemotherapy and radiation therapy, 5 year-survival rates have become 70–85% and also the so-called long-term survivors have increased in our country. This report reviews the prognosis and delayed complications of medulloblastoma in our institute. Cases were 14 boys and 11 girls from January,2010 to May 2019. Mean age was 6.1 years old (4 months to 14 years old). 18 cases receiver gross total removal and 12 cases were high risk group. Exclude recent 4 cases, 15 cases have indicated complete reaction though 6 cases had relapsed or new tumor. The results are that 5 year-survival rates in our institute is 86.7%, but 4 cases had neuro-psychological complications. 5 cases suffered from endocrinal disorders which were not confirmed after the end of all treatments. 2 secondary cancer had appeared 5 and 8 years after the first treatments. The more the survivor in medulloblastoma cases increase, neurosurgeons have to consider long term follow up more than 5 years and pay more attention to support activity of daily life of these patients.