RSS-Feed abonnieren
PDF herunterladen
DOI: 10.1055/a-2519-7038
Surgical Technical Nuance of Exoscopic Cerebral Bypass Surgery Using the Mitaka 4K3D Exoscope
Autoren
Abstract
Background and Objective Bypass surgery remains a crucial skill for neurosurgeons specializing in open or hybrid procedures. For years, these surgeries have been performed using an operating microscope. There have been limited publications on bypass surgeries using an exoscope. Here, we share our first-hand experience using the Mitaka HawkSight 4K3D HD exoscope in performing two bypass surgeries for moyamoya disease and intracranial atherosclerosis disease. The objective of the study is to show our experience and effectiveness of cerebral bypass with a Mitaka exoscope.
Methods We observed two patients operated with an Mitaka exoscope in our center in 2024.
Result The first case was a 35-year-old woman with moyamoya disease who presented with weakness for 1 month for which a combined bypass was done. The second case involved an 80-year-old male patient with cognitive impairment and right middle cerebral artery occlusion due to intracranial atherosclerosis disease, for which a direct bypass was done. In both instances, we utilized the exoscope with a 4K3D screen and 3D eyeglasses for enhanced visualization.
Conclusion Bypass surgery can be conducted using an exoscope, which provides 4K3D HD images displayed on a 55-inch screen, offering an optimal view for the entire operating room, including both scrubbed and unscrubbed personnel. Unlike an operating microscope, everyone sees the same image as the surgeon, enhancing coordination and understanding among the team. Mastering the exoscope requires a learning curve that depends on experience, repetition, and unwavering dedication.
Publikationsverlauf
Eingereicht: 10. Dezember 2024
Angenommen: 13. Januar 2025
Accepted Manuscript online:
22. Januar 2025
Artikel online veröffentlicht:
11. Februar 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
-
References
- 1 Fujimura M, Tominaga T, Kuroda S. et al; Research Committee on Moyamoya Disease (Spontaneous Occlusion of Circle of Willis) of the Ministry of Health, Labor Welfare, Japan, Guideline Committee 2021 of the Japan Stroke Society. 2021 Japanese Guidelines for the Management of Moyamoya Disease: Guidelines from the Research Committee on Moyamoya Disease and Japan Stroke Society. Neurol Med Chir (Tokyo) 2022; 62 (04) 165-170
- 2 Fiaschi P, Scala M, Piatelli G. et al. Limits and pitfalls of indirect revascularization in moyamoya disease and syndrome. Neurosurg Rev 2021; 44 (04) 1877-1887
- 3 Sasoh M, Ogasawara K, Kuroda K. et al. Effects of EC-IC bypass surgery on cognitive impairment in patients with hemodynamic cerebral ischemia. Surg Neurol 2003; 59 (06) 455-460 , discussion 460–463
- 4 Sabayan B, Goudarzi R, Ji Y. et al. Intracranial atherosclerosis disease associated with cognitive impairment and dementia: systematic review and meta-analysis. J Am Heart Assoc 2023; 12 (22) e032506
- 5 Burkhardt J-K, Lawton MT. Practice trends in intracranial bypass surgery in a 21-year experience. World Neurosurg 2019; 125: e717-e722
- 6 Hafez A, Elsharkawy A, Schwartz C. et al. Comparison of conventional microscopic and exoscopic experimental bypass anastomosis: a technical analysis. World Neurosurg 2020; 135: e293-e299
- 7 White TG, Klironomos G, Langer DJ, Katz J, Dehdashti AR. Combined internal maxillary artery to middle cerebral artery and in situ middle cerebral to middle cerebral artery bypass for complex middle cerebral artery aneurysm: 3-dimensional operative video. Oper Neurosurg (Hagerstown) 2020; 18 (04) E121-E122
- 8 Veldeman M, Rossmann T, Nurminen V. et al. 3D exoscopic versus microscopic superficial temporal artery to middle cerebral artery bypass surgery for moyamoya disease: a comparative series. Acta Neurochir (Wien) 2024; 166 (01) 254
- 9 Nossek E, Schneider JR, Kwan K. et al. Technical aspects and operative nuances using a high-definition 3-dimensional exoscope for cerebral bypass surgery. Oper Neurosurg (Hagerstown) 2019; 17 (02) 157-163
- 10 Montemurro N, Scerrati A, Ricciardi L, Trevisi G. The exoscope in neurosurgery: an overview of the current literature of intraoperative use in brain and spine surgery. J Clin Med 2021; 11 (01) 223
- 11 Rossmann T, Veldeman M, Nurminen V. et al. 3D exoscopes are noninferior to operating microscopes in aneurysm surgery: comparative single-surgeon series of 52 consecutive cases. World Neurosurg 2023; 170: e200-e213