Innovative neurosurgery by using neuroendoscope and exoscope

Abstract

Minimally invasive procedure is commonly required for recent neurosurgical therapy. Neuroendoscopic procedure is becoming more and more popular for that purpose. Another recent topic is heads-up surgery by using exoscope, which locates between microscope and endoscope. Okayama University induced neuroendoscope and exoscope at an early stage of availability and a number of procedures has been accumulated. In this presentation, video will be used to demonstrate how we set up and how we use endoscope and exoscope.

1. ETV (endoscopic third ventriculostomy) for obstructive hydrocephalus : ETV is more commonly performed than VP (ventriculo-peritoneal) shunt these days. Flexible scope with CCD camera at the tip makes the vision very clearly.

2. Extirpation of intraventricular tumor : Accurate biopsy can be performed and sometimes total tumor resection is achieved by using endoscope only.

3. Endoscopic transsphenoidal surgery for pituitary adenoma and parasellar tumor : With the use of navigation and 4K monitor, fine visualization of anatomical structures is obtained.

4. Hybrid surgery using microscope and neuroendoscope simultaneously : Endoscope can make 30 and 70 degree view which conventional microscope cannot see. Hybrid surgery is a terminology for simultaneous usage of microscope and endoscope and I will show representative cases.

5. Introduction of 3D exoscope - a dawn of heads-up surgery : Exoscope became 3D with high vision or 4K, thus, heads-up surgery with 3D glasses is attracting attention. In this pattern of surgery, everyone in the operating theater watches the same display and there is a sense of unity. Education of surgery using exoscope is meaningful and effective for medical students and residents. Exoscope is much smaller than microscope and an operator's position is always the same, thus, the operator feels less fatigue.

In this presentation, I will show our neuroendoscopic and exoscopic surgery by using video.