Exoscope-guided (VITOM 3D) single-stage removal of supratentorial cavernous angioma and hemangioblastoma
EANS Academy. Germanò A. 09/25/19; 275666; EP12027
Prof. Antonino Germanò
Prof. Antonino Germanò

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Background: In the recent years, the use of 3D-exoscope has emerged as a new operative technique for treating different neurosurgical diseases. It carries several advantages: 1) it allows neurosurgeons to operate in a confortable and stable position; 2) it is less space-occupying in comparison to the microscope; 3) the optics and 3D-screen offer an optimal stereoscopic view in comparison to the 2D exoscope, important for both surgical and training purposes; 4) although sharing with the endoscope the image quality and confortable surgeon's position, there is no conflict between the surgical instruments and the scope in the surgical field. We report a video describing the case of exoscope-guided single-stage removal with three-dimensional technology of a supratentorial cavernoma and a supratentorial hemangioblastoma during the same surgical procedure.
Methods: A 42-year-old man was admitted at our Neurosurgical Department with a history of generalized tonico-clonic seizures. Contrast-enhanced magnetic resonance (MR) revealed the presence of a left frontal cavernoma and a left T1 non-enhancing hypointese temporal lesion (hemangioblastoma). Resection of both lesions during the same surgical procedure was decided. The operation was carried out in the lateral position with the sole use of a 3D-exoscope (VITOM-3D, KARL STORZ GmbH&Co - Tuttlingen - Germany). The operating room set-up included the surgeons standing at the head of the patients with the operating and navigator screens in the front of them and the exoscope arm entering from the left side.
Results: The adopted strategy enabled a complete resection of both lesions. The post-operative course was uneventful and the patient was seizure-free; the antiepileptic drugs were discontinued three months after surgery.
Conclusions: The 3D-exoscope represents a promising surgical tool, which may became part of the neurosurgical armamentarium. Nevertheless, the conceivable capability to improve neurosurgical results will have to be explored.
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