Tag: 3D

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Application of the Robotic-Assisted Digital Exoscope for Resection of Posterior Fossa Tumors in Adults: A Series of 45 Cases

Operative Neurosurgery 25:397–407, 2023

Complete safe resection is the goal when pursuing surgical treatment for posterior fossa (PF) tumors. Efforts have led to the development of the exoscope that delineates tumors from non-neoplastic brain. This investigation aims to assess patient outcomes where PF tumor resection is performed with the exoscope by a retromastoid or suboccipital approach.

METHODS: A retrospective analysis was conducted for patients with PF tumors who underwent exoscope resection from 2017 to 2022. Patient demographics, clinical, operative, and outcome findings were collected. Extent of resection studies were also performed. Associations between perioperative data, discharge disposition, progression-free survival (PFS), and overall survival (OS) were evaluated.

RESULTS: A total of 45 patients (22 male patients) with a median age of 57 years were assessed. Eighteen (40%) and 27 patients (60%) were diagnosed with malignant and benign tumors, respectively. Tumor neurovascular involvement was found in 28 patients (62%). Twenty-four (53%) and 20 (44%) tumors formed in the cerebellum and cerebellopontine angle cistern, respectively. One tumor (2%) was found in the cervicomedullary junction. The mean extent of resection was 96.7% for benign and malignant tumors. The PFS and OS rate at 6 months (PFS6, OS6) was 89.7% and 95.5%, respectively. Neurological complications included sensory loss and motor deficit, with 11 patients reporting no postoperative symptoms. Of the neurological complications, 14 were temporary and 9 were permanent.

CONCLUSION: The exoscope is an effective intraoperative visualization tool for delineating PF tumors. In our series, we achieved low postoperative tumor volumes and a high gross total resection rate.

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3D printing applications in spine surgery: an evidence‑based assessment toward personalized patient care

European Spine Journal (2022) 31:1682–1690

Spine surgery entails a wide spectrum of complicated pathologies. Over the years, numerous assistive tools have been introduced to the modern neurosurgeon’s armamentarium including neuronavigation and visualization technologies. In this review, we aimed to summarize the available data on 3D printing applications in spine surgery as well as an assessment of the future implications of 3D printing.

Methods We performed a comprehensive review of the literature on 3D printing applications in spine surgery.

Results Over the past decade, 3D printing and additive manufacturing applications, which allow for increased precision and customizability, have gained significant traction, particularly spine surgery. 3D printing applications in spine surgery were initially limited to preoperative visualization, as 3D printing had been primarily used to produce preoperative models of patient-specific deformities or spinal tumors. More recently, 3D printing has been used intraoperatively in the form of 3D customizable implants and personalized screw guides.

Conclusions Despite promising preliminary results, the applications of 3D printing are so recent that the available data regarding these new technologies in spine surgery remains scarce, especially data related to long-term outcomes.

 

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A high-definition 3D exoscope as an alternative to the operating microscope in spinal microsurgery

J Neurosurg Spine 33:705–714, 2020

Since the 1970s, the operating microscope (OM) has been a standard for visualization and illumination of the surgical field in spinal microsurgery. However, due to its limitations (e.g., size, costliness, and the limited movability of the binocular lenses, in addition to discomfort experienced by surgeons due to the posture required), there are efforts to replace the OM with exoscopic video telescopes. The authors evaluated the feasibility of a new 3D exoscope as an alternative to the OM in spine surgeries.

METHODS Patients with degenerative pathologies scheduled for single-level lumbar or cervical spinal surgery with use of a high-definition 3D exoscope were enrolled in a prospective cohort study between January 2019 and September 2019. Age-, sex-, body mass index–, and procedure-matched patients surgically treated with the assistance of the OM served as the control group. Operative baseline and postoperative outcome parameters were assessed. Periprocedural handling, visualization, and illumination by the exoscope, as well as surgeons’ comfort level in terms of posture, were scored using a questionnaire.

RESULTS A 3D exoscope was used in 40 patients undergoing lumbar posterior decompression (LPD) and 20 patients undergoing anterior cervical discectomy and fusion (ACDF); an equal number of controls in whom an OM was used were studied. Compared with controls, there were no significant differences for mean operative time (ACDF: 132 vs 116 minutes; LPD: 112 vs 113 minutes) and blood loss (ACDF: 97 vs 93 ml; LPD: 109 vs 55 ml) as well as postoperative improvement of symptoms (ACDF/Neck Disability Index: p = 0.43; LPD/Oswestry Disability Index: p = 0.76). No intraoperative complications occurred in either group. According to the attending surgeon, the intraoperative handling of instruments was rated to be comparable to that of the OM, while the comfort level of the surgeon’s posture intraoperatively (especially during “undercutting” procedures) was rated as superior. In cases of ACDF procedures and long approaches, depth perception, image quality, and illumination were rated as inferior when compared with the OM. By contrast, for operating room nursing staff participating in 3D exoscope procedures, the visualization of intraoperative process flow and surgical situs was rated to be superior to the OM, especially for ACDF procedures.

CONCLUSIONS A 3D exoscope seems to be a safe alternative for common spinal procedures with the unique advantage of excellent comfort for the surgical team, but the drawback is the still slightly inferior visualization/illumination quality compared with the OM.

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A combined dual-port endoscope-assisted pre- and retrosigmoid approach to the cerebellopontine angle

A combined dual-port endoscope-assisted pre- and retrosigmoid approach to the cerebellopontine angle- an extensive anatomo-surgical study

Neurosurg Rev (2014) 37:597–608

The use of the endoscope in the cerebellopontine angle (CPA) has been suggested to minimize cerebellar retraction and reduce the size of the craniotomy. 3D endoscopy combines the benefits of conventional 2D endoscopy with the added benefit of stereoscopic perception, though improved visualization alone does not guarantee improved surgical maneuverability and a better surgical outcome. We propose a new combined dual-port endoscope-assisted pre- and retrosigmoid approach to improve visualization and accessibility of the CPA with shortened distances and increased surgical maneuverability of neurovascular structures.

We analyze surgical exposure and maneuverability of this approach and compare it with the surgical microscopic and a conventional single-port endoscope-assisted retrosigmoid approach. This combined pre- and retrosigmoid approach was performed on eight cadaveric heads (16 sides). The endoscopic probe was inserted through the presigmoid surgical port while surgical manipulation was performed through the retrosigmoid corridor. The CPA was divided into three compartments, from medial to lateral, the anteromedial, and the middle and the posterolateral. The microscope provided good visualization of the posterolateral and middle compartments, whereas poor visualization was offered of the anteromedial compartment. The dual-port endoscopic approach dramatically improved visualization and surgical maneuverability of the anteromedial compartments, clivus, and related neurovascular structures. Additionally, the 3D endoscope allowed for a better understanding of the surgical anatomy of the CPA and improved visualization of structures located in the anteromedial compartments towards the midline.

This approach allowed for full realization of the benefits of endoscopic-assisted technique by improving surgical access and maneuverability.

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