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Case Reports
. 2025 Jan 11;61(1):101.
doi: 10.3390/medicina61010101.

Implementation of ORBEYE®-Exoscope in the Operative Treatment of Spinal Dural Arteriovenous Fistula

Nikolay Tonchev  1 , Belal Neyazi  1 , Klaus-Peter Stein  1 , I Erol Sandalcioglu  1 , Ali Rashidi  1
Affiliations
Case Reports

Implementation of ORBEYE®-Exoscope in the Operative Treatment of Spinal Dural Arteriovenous Fistula

Nikolay Tonchev et al. Medicina (Kaunas). .

Abstract

Spinal dural arteriovenous fistulas (sDAVFs) are rather uncommon lesions of the spine. In sDAVFs, which represent the most frequent form of vascular malformations of the spine, operative treatment remains the most common treatment modality. In operative surgery, visualization and pathology detection have a key impact on the results of the neurosurgical treatment of an sDAVF. The exoscope is one of the most recent imaging devices developed alongside the microscope and endoscope. The exoscope is being increasingly applied in neurosurgical procedures as an alternative to operative microscopes due to various advantages, such as its non-space-occupying camera, excellent visualization of the anatomical details and the perfect teaching possibilities it thus provides. In this publication, we present our experience in the treatment of a patient with an sDAVF, where surgery was performed exclusively with an ORBEYE-exoscope for the entire duration of the procedure. This report outlines the workflow and some of the technical pitfalls involved in managing this vascular pathology using the exoscopic technique.

Keywords: Orbeye®; exoscope; neurosurgery; spinal dural arteriovenous fistula.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Case illustration: Pre-operative sagittal T2-weighted (A) and FLAIR MR imaging (B) of the thoracic region shows diffuse central spinal cord edema (white arrows) and flow voids (yellow arrow).
Figure 2
Figure 2
(A) View of super-selective digital subtraction angiography (DSA) with the spinal DAVF showing the feeders from the radicular meningeal artery. (B) After the shunt spot (black arrows), the AV-Fistula continues upwards intradurally, draining into the perimedulary veins.
Figure 3
Figure 3
Spinal thoracic (T9) DAVF seen in ICG video-angiography mode (A) using digital 3D exoscope. Intraoperative ORBEYE-exoscope view (B) of the arterialized intradural vein (yellow arrows).
Figure 4
Figure 4
High-definition intraoperative exoscope image of the intradural venous vessels (yellow arrow) after bipolar coagulation.
Figure 5
Figure 5
Case results: Post-operative sagittal (A) and axial (B) T2-weighted MR images show decrease in spinal cord edema (white arrows) three months after the operation.
See this image and copyright information in PMC

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