Efficacy of a High-definition Three-dimensional Exoscope in Simultaneous Transcranial and Endoscopic Endonasal Surgery: A Case Report

Abstract

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.

Combined simultaneous endoscopic endonasal and transcranial surgery using high‐definition three‐dimensional exoscope for malignant tumors of the anterior skull base

“…ORBEYE delivers ultrahigh‐definition 4K images in 3D, and its depth of field and visual range surpass those of standard operative microscopes 17 . Furthermore, it has demonstrated several advantages, particularly when combined with simultaneous EETS 14,16,17 . First, the use of a compact exoscope, as opposed to a conventional microscope, creates a space above the surgical site, facilitating the simultaneous insertion of an endoscope within the same operative field.…”

“…In contrast, an exoscope supports efficient microsurgical tasks from any visual angle while ensuring the surgeon's comfort. Several challenges are associated with the use of an exoscope, including the potential for visual fatigue, the initial learning phase, and financial implications 14,17 . Achieving a comfortable stereoscopic perspective with 3D glasses may be initially challenging, leading to physical discomfort for surgeons that manifests as headaches, visual tension, and other related symptoms 14 …”

“…As described previously, 14 neurosurgeons can perform simultaneous EETS by observing a 55‐inch ORBEYE display positioned directly over the patient's feet, even with a 55‐inch endoscope screen. The strategic repositioning of the ORBEYE monitor from directly above the patient's feet to the bottom left facilitated the simultaneous execution of three separate surgical interventions: harvesting of the ALT flap by plastic surgeons, initiation of the endoscopic transnasal approach by otolaryngologists, and initiation of the transcranial approach by neurosurgeons.…”

“…However, performing the transcranial procedure with the microscope and the endonasal method with an endoscope concurrently is inherently challenging for otolaryngologists and neurosurgeons given the substantial size of the surgical microscope placed directly over the operative site. Moreover, the successive performance of transcranial and nasal methods extends the overall surgical duration 14 …”

“…Moreover, the successive performance of transcranial and nasal methods extends the overall surgical duration. 14 This study describes an effective integration of EETS using a high-definition three-dimensional exoscope (HD-3D Exoscope), which can serve as an alternative to traditional microscopy for the treatment of malignant tumors located in the ASB.…”