Three-Dimensional Exoscopic Temporal Bone Resections for Advanced Head and Neck Cancer

Abstract

Objectives The three-dimensional (3D) exoscope has several advantages over the operative microscope (OM) but has not been extensively reported for its use in malignant temporal bone resections (TBR). We sought to demonstrate the feasibility of performing TBR, both lateral (LTBR) and subtotal (STBR), using the 3D exoscope for head and neck cancers.

Design present study is a retrospective chart review from August 2016 until August 2019.

Setting The study was conducted at a tertiary care center.

Participants Patients were undergoing TBR with the Karl Storz VITOM 3D exoscope.

Main Outcome Measures Demographics, tumor and surgical characteristics, patient outcomes were the primary measurements of this study.

Results Fifty-five patients underwent 3D exoscopic TBR from 2016 through 2019 of which 18% (n = 10) underwent STBR. The 3D exoscope was used uninterruptedly in all procedures with no intraoperative complications. Most tumors were primarily T3 (42%, n = 23) or T4 (55%, n = 30) and of cutaneous (62%, n = 34) and parotid (27%, n = 15) origin. These TBR were often accompanied by infratemporal fossa resections (87%, n = 48), auriculectomies (47%, n = 26), mandibulectomies (53%, n = 29), and parotidectomies (96%, n = 53). On final pathology, 24% (n = 13) had microscopically positive margins. Over the study period, 20% (n = 11) of patients had recurrences with a median recurrence time of 5 months (range: 2–30 months).

Conclusion In the largest case series of LTBR and STBR under exclusive 3D exoscopic visualization to date, we demonstrate the 3D exoscope is a feasible alternative to the operative microscope for LTBR and STBR. While oncologic outcomes remain to be clarified, it carries significant potential for use in complex oncologic procedures.

Keywords

temporal bone - exoscope - malignancy - three-dimensional

^* Co-first authors.

Publication History

Received: 22 July 2020

Accepted: 23 December 2020

Article published online:
15 March 2021

• References

• 1 Langer DJ, White TG, Schulder M, Boockvar JA, Labib M, Lawton MT. Advances in intraoperative optics: a brief review of current exoscope platforms. Oper Neurosurg (Hagerstown) 2020; 19 (01) 84-93
• 2 Ricciardi L, Chaichana KL, Cardia A. et al. The exoscope in neurosurgery: an innovative “point of view”. A systematic review of the technical, surgical and educational aspects. World Neurosurg 2019
• 3 Sack J, Steinberg JA, Rennert RC. et al. Initial experience using a high-definition 3-dimensional exoscope system for microneurosurgery. Oper Neurosurg (Hagerstown) 2018; 14 (04) 395-401
• 4 Kwan K, Schneider JR, Du V. et al. Lessons learned using a high-definition 3-dimensional exoscope for spinal surgery. Oper Neurosurg (Hagerstown) 2019; 16 (05) 619-625
• 5 Garneau JC, Laitman BM, Cosetti MK, Hadjipanayis C, Wanna G. The use of the exoscope in lateral skull base surgery: advantages and limitations. Otol Neurotol 2019; 40 (02) 236-240
• 6 Smith S, Kozin ED, Kanumuri VV. et al. Initial experience with 3-dimensional exoscope-assisted transmastoid and lateral skull base surgery. Otolaryngol Head Neck Surg 2019; 160 (02) 364-367
• 7 Minoda R, Miwa T. Non-microscopic middle ear cholesteatoma surgery: a case report of a novel head-up approach. Otol Neurotol 2019; 40 (06) 777-781
• 8 Rubini A, Di Gioia S, Marchioni D. 3D exoscopic surgery of lateral skull base. Eur Arch Otorhinolaryngol 2020; 277 (03) 687-694
• 9 Magliocca KR, Ballestas SA, Baddour HM, Pradilla G, Solares CA. Update in temporal bone resection outcomes. Curr Otorhinolaryngol Rep 2019; 7: 58-64
• 10 Gidley PW, Roberts DB, Sturgis EM. Squamous cell carcinoma of the temporal bone. Laryngoscope 2010; 120 (06) 1144-1151
• 11 Morris LG, Mehra S, Shah JP, Bilsky MH, Selesnick SH, Kraus DH. Predictors of survival and recurrence after temporal bone resection for cancer. Head Neck 2012; 34 (09) 1231-1239
• 12 Garneau JC, Laitman BM, Cosetti MK, Hadjipanayis C, Wanna GB. Repair of a temporal bone encephalocele with the surgical exoscope. Otol Neurotol 2020; 41 (04) 561
• 13 Babar-Craig H, Banfield G, Knight J. Prevalence of back and neck pain amongst ENT consultants: national survey. J Laryngol Otol 2003; 117 (12) 979-982
• 14 Wong K, Grundfast KM, Levi JR. Assessing work-related musculoskeletal symptoms among otolaryngology residents. Am J Otolaryngol 2017; 38 (02) 213-217
• 15 Lobo D, Gandarillas MA, Sánchez-Gómez S, Megía R. Work-related musculoskeletal symptoms in otorhinolaryngology and their relationship with physical activity. A nationwide survey. J Laryngol Otol 2019; 133 (08) 713-718
• 16 Vijendren A, Devereux G, Kenway B. et al. Effects of prolonged microscopic work on neck and back strain amongst male ENT clinicians and the benefits of a prototype postural support chair. Int J Occup Saf Ergon 2019; 25 (03) 402-411
• 17 Carlucci C, Fasanella L, Ricci Maccarini A. Exolaryngoscopy: a new technique for laryngeal surgery. Acta Otorhinolaryngol Ital 2012; 32 (05) 326-328
• 18 Ariffin MHM, Ibrahim K, Baharudin A, Tamil AM. Early experience, setup, learning curve, benefits, and complications associated with exoscope and three-dimensional 4K hybrid digital visualizations in minimally invasive spine surgery. Asian Spine J 2020; 14 (01) 59-65