Exoscope-Guided (VITOM 3D) Single-Stage Removal of Supratentorial Cavernous Angioma and Hemangioblastoma: 3-Dimensional Operative Video

Abstract

This video shows an exoscope-guided single-stage resection with 3-dimensional technology of a supratentorial cavernoma and a supratentorial hemangioblastoma during the same surgical procedure. The patient is a 42-yr-old man 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). 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. As recently highlighted, the 3D-exoscope 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. The adopted strategy enabled a complete resection of both lesions. The postoperative course was uneventful and the patient was seizure-free; the antiepileptic drugs were discontinued 3 mo after surgery. The 3D-exoscope represents a promising surgical tool, which may become part of the neurosurgical armamentarium. Nevertheless, the conceivable capability to improve neurosurgical results will have to be explored. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The patient has consented to the submission of the surgical video for submission to the journal.