The role of Vitom-3D in the management of spinal meningiomas: review of the literature and illustrative case

Abstract

The favorable outcome generally associated with spinal meningioma surgery is the result of the continuing refinement of the surgical technique, the use of intraoperative neuromonitoring, and a better understanding of the tumor biological behavior. Among all the technological advancements, visualization tools are the keys to any successful surgical procedure. The operating microscope is the gold standard in all neurosurgical procedures. In recent years, high-definition exoscope systems have entered the field of neurosurgery, as another tool in the armamentarium of the contemporary neurosurgeon. After initial experiences and technical improvements, the exoscope has proven to be best suited for spinal procedures. This study aims to briefly review the exoscope journey in neurosurgery, with a special focus on spinal meningioma surgery. Benefits and limitations are analyzed and an illustrative case is reported. Spinal meningiomas removal under exoscope visualization has proven to be feasible, efficient, and safe. Indication for the use of the exoscope greatly depends on meningioma size, consistency, relationship to surrounding neurovascular structures, and the surgeon's experience. Switching to the operating microscope, if deemed safer, should always be considered.

The Role of 3D Exoscope Systems in Neurosurgery: An Optical Innovation

“…Spinal meningiomas are an example of a pathology that can benefit from the 3D exoscope technology. With spinal meningiomas being mostly within the cervical or thoracic regions, a large surgical view is required because these regions present deeper operative fields [ 16 , 18 ]. The 3D exoscope ideally presents the operative environment illustrated broadly in a 3D landscape [ 18 , 19 ].…”

“…With spinal meningiomas being mostly within the cervical or thoracic regions, a large surgical view is required because these regions present deeper operative fields [ 16 , 18 ]. The 3D exoscope ideally presents the operative environment illustrated broadly in a 3D landscape [ 18 , 19 ]. Meanwhile, the tumor itself is slow-growing and is quite small, presenting the need for optimal magnification and illumination of the epidural spinal canal, surrounding vessels, and tumor-dural attachment points [ 18 ].…”

“…The 3D exoscope ideally presents the operative environment illustrated broadly in a 3D landscape [ 18 , 19 ]. Meanwhile, the tumor itself is slow-growing and is quite small, presenting the need for optimal magnification and illumination of the epidural spinal canal, surrounding vessels, and tumor-dural attachment points [ 18 ]. As meningiomas do, they could spread across three-laminae layers, warranting for dynamic imaging adjustments.…”

“…As meningiomas do, they could spread across three-laminae layers, warranting for dynamic imaging adjustments. Moreover, spinal surgery often requires fluoroscopy, meaning the OM has to accommodate for the multiple surgical transitions [ 18 ]. The 3D exoscope easily accommodates for flexible image adjustments, while also not interfering with fluoroscopic placement, allowing for a better tumor dissection and an efficient surgical experience [ 18 , 19 ].…”

“…Moreover, spinal surgery often requires fluoroscopy, meaning the OM has to accommodate for the multiple surgical transitions [ 18 ]. The 3D exoscope easily accommodates for flexible image adjustments, while also not interfering with fluoroscopic placement, allowing for a better tumor dissection and an efficient surgical experience [ 18 , 19 ]. In addition, the large working distance, the camera holding arm being on the opposite side of the surgeon, the exoscope being at the center of the surgical field, with the monitor provided in front of the surgeon while using the 3D exoscope will eliminate conflict between surgical instruments, making the surgical setting more ergonomically favorable.…”