Posterior cranial fossa surgery with a 3D Exoscope: a single-center survey-based analysis and a literature review

Pier Paolo Mattogno; Giuseppe Maria Della Pepa; Grazia Menna; Ludovico Agostini; Alessio Albanese; Gianpiero Tamburrini; Simona Gaudino; Alessandro Olivi; Francesco Doglietto

doi:10.1016/j.wneu.2024.05.012

Posterior cranial fossa surgery with a 3D Exoscope: a single-center survey-based analysis and a literature review

World Neurosurg. 2024 May 9:S1878-8750(24)00765-4. doi: 10.1016/j.wneu.2024.05.012. Online ahead of print.

Authors

Pier Paolo Mattogno¹, Giuseppe Maria Della Pepa¹, Grazia Menna², Ludovico Agostini¹, Alessio Albanese³, Gianpiero Tamburrini⁴, Simona Gaudino⁵, Alessandro Olivi³, Francesco Doglietto³

Affiliations

¹ Neurosurgery Unit, Department of Neurosciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy.
² Neurosurgery Unit, Department of Neurosciences, Catholic University School of Medicine, Rome, Italy. Electronic address: mennagrazia@gmail.com.
³ Neurosurgery Unit, Department of Neurosciences, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy; Neurosurgery Unit, Department of Neurosciences, Catholic University School of Medicine, Rome, Italy.
⁴ Neurosurgery Unit, Department of Neurosciences, Catholic University School of Medicine, Rome, Italy; Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
⁵ Department of Radiological Sciences, Catholic University, School of Medicine, Largo A. Gemelli 1, 00168, Rome, Italy.

PMID: 38734169
DOI: 10.1016/j.wneu.2024.05.012

Abstract

Background: The potential advantages of exoscopy have been discussed theoretically for a long time. Such a concept holds significance, especially in the specific setting of the posterior cranial fossa (PCF), characterized by complex anatomy and long and narrow surgical corridors with relatively extreme working angles.

Aim: We aimed to: 1) analyze the institutional preliminary case-based data on the use of the Robotic 3D Exoscope AEOS Aesculap in three different PCF approaches: retrosigmoid (RSA), midline suboccipital (MSA), and supra cerebellar infratentorial (SIA) via feedbacks was collected using a 20-point questionnaire. 2) perform a comprehensive review of the literature concerning the use of EX in PCF surgery RESULTS: A total of 38 patients with neurosurgical pathologies underwent a neurosurgical procedure using the EX (Robotic 3D exoscope AEOS Aesculap) at our institution between January and March 2022. 21 surgeons were involved in the abovementioned PCF surgeries and answered the questionnaire. The main perceived advantages were in terms of ergonomics (67%) and magnification (52%) and visualization of extreme angles. The main reported disadvantage was color vision (16, 76%), followed by manual mobility (24%). Concerning the review, the search of the literature yielded a total of 177 results. Upon full-text review, 17 articles were included, including 153 patients.

Conclusions: In conclusion, our study provides a comprehensive evaluation of the advantages and challenges associated with using the exoscope in posterior fossa surgery, setting a precedent as the first to report on a questionnaire-based analysis of exoscope utilization in this specific domain.