International expert consensus statement about methods and indications for keyhole microneurosurgery from International Society on Minimally Invasive Neurosurgery

Lan, Qing; Sughrue, Michael E.; Hopf, Nikolai J.; Mori, Kentaro; Park, Jaechan; Andrade-Barazarte, Hugo; Balamurugan, M; Cenzato, Macro; Broggi, Giovanni; Kang, Dezhi; Kikuta, Ken-ichiro; Zhao, Yuanli; Zhang, Hengzhu; Irie, Shinsuke; Li, Yuping; Liew, B S; Kato, Yōkō

doi:10.1007/s10143-019-01188-z

Cited by 17 publications

(18 citation statements)

References 92 publications

(196 reference statements)

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“…The rate of complications both intra- and postoperatively following exoscopic surgery was low. These findings are in line with previous studies [ 1 , 2 , 4 , 5 , 29 ].…”

Section: Discussionsupporting

confidence: 94%

“…The surgical satisfaction after having performed a procedure with the Aeos was high in 78.95% of all cases. This high level of contentment is comparable or even better than described in the current literature [ 1 , 5 , 6 , 28 ]. The rate of complications both intra- and postoperatively following exoscopic surgery was low.…”

Section: Discussionsupporting

confidence: 78%

“…The development and implementation of three-dimensional (3D) Exoscopes in the daily routine of neurosurgical practice is a matter of current debate [ 1 , 2 , 3 , 4 , 5 ]. Superior ergonomic comfort, improved image quality and magnification, increased accessibility of the surgical field and enhanced experience for residents during the surgical procedure are noted as the main advantages versus the use of the established standard operating microscope (OPMI) [ 1 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a Novel Three-Dimensional Robotic Digital Microscope (Aeos) in Neurosurgery

Maurer

Prinz

Qasem

et al. 2021

Cancers

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Objective: Current literature debates the role of newly developed three-dimensional (3D) Exoscopes in the daily routine of neurosurgical practice. So far, only a small number of cadaver lab studies or case reports have examined the novel Aesculap Aeos Three-Dimensional Robotic Digital Microscope. This study aims to evaluate the grade of satisfaction and intraoperative handling of this novel system in neurosurgery. Methods: Nineteen neurosurgical procedures (12 cranial, 6 spinal and 1 peripheral nerve) performed over 9 weeks using the Aeos were analyzed. Ten neurosurgeons of varying levels of training were included after undergoing device instruction and training. Following every surgery, a questionnaire consisting of 43 items concerning intraoperative handling was completed. The questionnaires were analyzed using descriptive statistics. Results: No intraoperative complications occurred. Surgical satisfaction was ranked high (78.95%). In total, 84.21% evaluated surgical ergonomics as satisfactory, while 78.95% of the surgeons would like to use this system frequently. Image quality, independent working zoom function and depth of field were perceived as suboptimal by several neurosurgeons. Conclusion: The use of Aeos is feasible and safe in microsurgical procedures, and surgical satisfaction was ranked high among most neurosurgeons in our study. The system might offer advanced ergonomic conditions in comparison to conventional ocular-based microscopes.

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“…The rate of complications both intra- and postoperatively following exoscopic surgery was low. These findings are in line with previous studies [ 1 , 2 , 4 , 5 , 29 ].…”

Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of a Novel Three-Dimensional Robotic Digital Microscope (Aeos) in Neurosurgery

Maurer

Prinz

Qasem

et al. 2021

Cancers

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“…The endoscopic endonasal route is now a well-accepted approach for many midline skull base and parasellar non-pituitary tumors. In our experience and that of others, using smaller incisions with more focused craniotomies, or the natural endonasal corridor facilitate less brain exposure, rapid healing, reduced pain need for narcotics, and a greater willingness for patients to mobilize and leave the hospital soon after surgery [15,17,31,33,[39][40][41]. Similarly, strict complication avoidance protocols help facilitate short LOS, reduced ICU use, and lower overall complication rates [42,43].…”

Section: Minimally Invasive Tumor Removal and Complication Avoidance Protocolsmentioning

confidence: 69%

Streamlining brain tumor surgery care during the COVID-19 pandemic: A case-control study

et al. 2021

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Background The COVID-19 pandemic forced a reconsideration of surgical patient management in the setting of scarce resources and risk of viral transmission. Herein we assess the impact of implementing a protocol of more rigorous patient education, recovery room assessment for non-ICU admission, earlier mobilization and post-discharge communication for patients undergoing brain tumor surgery. Methods A case-control retrospective review was undertaken at a community hospital with a dedicated neurosurgery and otolaryngology team using minimally invasive surgical techniques, total intravenous anesthesia (TIVA) and early post-operative imaging protocols. All patients undergoing craniotomy or endoscopic endonasal removal of a brain, skull base or pituitary tumor were included during two non-overlapping periods: March 2019–January 2020 (pre-pandemic epoch) versus March 2020–January 2021 (pandemic epoch with streamlined care protocol implemented). Data collection included demographics, preoperative American Society of Anesthesiologists (ASA) status, tumor pathology, and tumor resection and remission rates. Primary outcomes were ICU utilization and hospital length of stay (LOS). Secondary outcomes were complications, readmissions and reoperations. Findings Of 295 patients, 163 patients were treated pre-pandemic (58% women, mean age 53.2±16 years) and 132 were treated during the pandemic (52% women, mean age 52.3±17 years). From pre-pandemic to pandemic, ICU utilization decreased from 92(54%) to 43(29%) of operations (p<0.001) and hospital LOS≤1 day increased from 21(12.2%) to 60(41.4%), p<0.001, respectively. For craniotomy cohort, median LOS was 2 days for both epochs; median ICU LOS decreased from 1 to 0 days (p<0.001), ICU use decreased from 73(80%) to 29(33%),(p<0.001). For endonasal cohort, median LOS decreased from 2 to 1 days; median ICU LOS was 0 days for both epochs; (p<0.001). There were no differences pre-pandemic versus pandemic in ASA scores, resection/remission rates, readmissions or reoperations. Conclusion This experience suggests the COVID-19 pandemic provided an opportunity for implementing a brain tumor care protocol to facilitate safely decreasing ICU utilization and accelerating discharge home without an increase in complications, readmission or reoperations. More rigorous patient education, recovery room assessment for non-ICU admission, earlier mobilization and post-discharge communication, layered upon a foundation of minimally invasive surgery, TIVA anesthesia and early post-operative imaging are possible contributors to these favorable trends.

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“…

MiniMally invasive neurosurgical techniques have been developed over many decades, fostered in part by endoscopic visualization. [1][2][3][4][5][6][7][8] Keyhole surgery was introduced by Donald Wilson in 1971. 8 Since the 1990s, Axel Perneczky and others have refined the keyhole concept by applying modern microneurosurgical techniques in skull base and vascular neurosurgery.

…”

mentioning

confidence: 99%

Supraorbital and mini-pterional keyhole craniotomies for brain tumors: a clinical and anatomical comparison of indications and outcomes in 204 cases

Avery

Mallari

Barkhoudarian

et al. 2022

Journal of Neurosurgery

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OBJECTIVE The authors’ objective was to compare the indications, outcomes, and anatomical limits of supraorbital (SO) and mini-pterional (MP) craniotomies in patients with intra- and extraaxial brain tumors, and to assess approach selection, utility of endoscopy, and surgical field overlap. METHODS A retrospective analysis was conducted of all brain tumor patients who underwent an SO or MP approach. The analyzed characteristics included pathology, endoscopy use, extent of resection, length of stay (LOS), and complications. On the basis of preoperative MRI data, tumor heatmaps were constructed to compare surgical access provided by both routes, including coronal projection heatmaps for parasellar tumors. RESULTS From 2007 to 2020, 158 patients underwent 173 (84.8%) SO craniotomies and 30 patients underwent 31 (15.2%) MP craniotomies; 71 (34.8%) procedures were reoperations. Of these 204 operations, 110 (63.6%) SO and 21 (67.7%) MP approaches were for extraaxial tumors (meningiomas in 65% and 76.2%, respectively). Gliomas and metastases together represented 84.1% and 70% of intraaxial tumors accessed with SO and MP approaches, respectively. Overall, 56.1% of tumors accessed with the SO approach and 41.9% of those accessed with the MP approach were in the parasellar region. Axial projection heatmaps showed that SO access extended along the entire ipsilateral and medial contralateral anterior cranial fossa, parasellar region, ipsilateral sylvian fissure, medial middle cranial fossa, and anterior midbrain, whereas MP access was limited to the ipsilateral middle cranial fossa, sylvian fissure, lateral parasellar region, and posterior aspect of anterior cranial fossa. Coronal projection heatmaps showed that parasellar access extended further superiorly with the SO approach compared with that of the MP approach. Endoscopy was utilized in 98 (56.6%) SO craniotomies and 7 (22.6%) MP craniotomies, with further tumor resection in 48 (49%) and 5 (71.4%) cases, respectively. Endoscope-assisted tumor removal was clustered in areas that were generally at farther distances from the craniotomy or in angled locations such as the cribriform plate region where microscopic visualization is limited. Gross-total or near-total resection was achieved in 120/173 (69%) SO approaches and 21/31 (68%) MP approaches. Major complications occurred in 11 (6.4%) SO approaches and 1 (3.2%) MP approach (p = 0.49). The median LOS decreased to 2 days in the last 2 years of the study. CONCLUSIONS This clinical experience suggests the SO and MP craniotomies are versatile, safe, and complementary approaches for tumors located in the anterior and middle cranial fossae and perisylvian and parasellar regions. The SO route, used in 85% of cases, achieved greater overall reach than the MP route. Both approaches may benefit from expanded visualization with endoscopy.

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International expert consensus statement about methods and indications for keyhole microneurosurgery from International Society on Minimally Invasive Neurosurgery

Cited by 17 publications

References 92 publications

Evaluation of a Novel Three-Dimensional Robotic Digital Microscope (Aeos) in Neurosurgery

Evaluation of a Novel Three-Dimensional Robotic Digital Microscope (Aeos) in Neurosurgery

Streamlining brain tumor surgery care during the COVID-19 pandemic: A case-control study

Supraorbital and mini-pterional keyhole craniotomies for brain tumors: a clinical and anatomical comparison of indications and outcomes in 204 cases

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