2025 Volume 53 Issue 2 Pages 75-81
In recent years, exoscopes have been shown to be more useful than microscopes in reducing surgeon fatigue, sharing information, and educating young neurosurgeons. In this study, we investigated whether microscopes could be replaced by exoscopes during cerebrovascular surgery.
The study included 149 cases of cerebrovascular surgery in which direct surgery was performed using an exoscope between July 31, 2021, and August 31, 2023 (clipping: 45 ruptured cerebral aneurysms, 64 unruptured cerebral aneurysms, 1 unruptured cerebral aneurysm trap + bypass, removal of 14 intracerebral hematomas, 5 arteriovenous malformations, 10 superficial temporal artery [STA]-middle cerebral artery (MCA) anastomoses, 9 carotid endarterectomies, and 1 arteriovenous fistula).
When comparing exoscopes and microscopes for ruptured and unruptured cerebral aneurysms, no clear difference was observed in the time required for clipping surgery. For STA-MCA anastomosis, the number of cases of thrombus formation during surgery was lower in the exoscope group, and the postoperative patency rate and operation time tended to be better in the exoscope group.
During four-hands surgery, if the operator was on the left side, the assistant’s monitor display was inverted and rotated counterclockwise. If the operator was on the right side, the display was not inverted but was rotated counterclockwise, allowing the assistant to operate the device without discomfort. Although this was the first time all surgeons had used an exoscope, they were able to complete the surgeries without switching to a microscope. Compared with a microscope, an exoscope offers several advantages, including a more comfortable posture for the operator, improved information sharing, and better feasibility for four-hands surgery. Therefore, a complete transition from a microscope to an exoscope was determined to be possible.
