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      Exoscope-assisted temporal bone resection: operative videos of the lateral and total techniques

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          Abstract

          Skull base malignancies arising from the parotid gland, skin, or external auditory canal (EAC) can potentially involve the temporal bone. Management of these invasive tumors represents a true challenge considering the critical neurovascular relationships. Exoscope-assisted temporal bone resection (TBR) plays a crucial role in addressing such malignancies. The extent of disease is evaluated using the Pittsburgh staging system, which then guides the boundaries of resection. Lateral TBR (LTBR) relies on removal of the EAC and lateral ossicles and is generally appropriate for stage T1 and T2 tumors. Total TBR (TTBR) is reserved for high-grade tumors involving the petrous apex.

          The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23135

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          Surgeon's comfort: The ergonomics of a robotic exoscope using a head-mounted display

          Anto Abramovic, Matthias Demetz, Aleksandrs Krigers … (2021)
          Introduction Conventional microscopes have certain limitations in terms of posture and ergonomics. Monitor-based exoscopes could solve this problem and thereby lead to less work-related sick leave for surgeons. Research question The aim of this study was to assess the ergonomics, usability, and neurosurgeon's comfort of a novel three-dimensional head-mounted display-based exoscope in a standardized setting. Material & Methods 34 neurosurgeons participated in a workshop on the exoscope, which features a head-mounted display and a head gesture-triggered control panel. After completion of a custom-made 10-step microsurgical exercise, image quality and comfort were assessed using a questionnaire. The participants' posture during the exercise was analyzed using a video motion analysis software. Results 34 participants (median neurosurgical experience: 6 years) were included. The median time to complete the exercise was 12 ​min [IqR 9.4, 15.0]. Younger participants (p ​= ​0.005) and those with video game experience (p ​= ​0.03) had a significantly steeper learning curve. The median overall satisfaction was at 80% in general and 82% for image quality. The median upper body as well as the median head coronal displacement from the neutral axis were 0°. Participants with less microsurgical experience showed less head/body displacement during the exercise (p ​= ​0.01). Discussion and conclusion Using the microsurgical training tool, we were able to depict a steep learning curve with a sufficient learnability of the most relevant commands. The exoscope excelled in usability, image quality as well as in ergonomic and favorable posture and could thus become an alternative to conventional microscopes due to the potentially elevated surgeons' comfort.
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            Temporal bone resection for lateral skull-base malignancies.

            Gautam U Mehta, Thomas Muelleman, Derald Brackmann … (2020)
            Malignancies involving the temporal bone are increasingly common and require specialized multi-disciplinary care. Given this complex location, involvement of the lateral skull base and local neurovascular structures is common. In this review we discuss general principles for temporal bone resection, as well as alternative and complementary surgical approaches that should be considered in the management of patients with temporal bone cancer.
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              Exoscopic En Bloc Carotid-Sparing Total Temporal Bone Resection: Feasibility Study and Operative Technique.

              Rima S Rindler, Roberto M Soriano, Mohamed M Elsherbini … (2022)
              To delineate the steps of exoscopic en bloc carotid artery-sparing total temporal bone resection for malignancies involving the temporal bone in a cadaveric model.
              Article 0 comments Cited 3 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Neurosurg Focus Video
                Journal ID (iso-abbrev): Neurosurg Focus Video
                Journal ID (publisher-id): Neurosurg Focus Video
                Title: Neurosurgical Focus: Video
                Publisher: American Association of Neurological Surgeons
                ISSN (Electronic): 2643-5217
                Publication date Collection: January 2024
                Publication date (Electronic): 01 January 2024
                Volume: 10
                Issue: 1 , Use of the Exoscope in Neurosurgery
                Electronic Location Identifier: V11
                Affiliations
                [1 ]Department of Otolaryngology and
                [2 ]Department of Neurosurgery, Emory University, Atlanta, Georgia
                Author notes
                Correspondence C. Arturo Solares: Emory University, Atlanta, GA. csolare@ 123456emory.edu .

                INCLUDE WHEN CITING DOI: 10.3171/2023.10.FOCVID23135.

                Disclosures Dr. Solares reported personal fees from Stryker outside the submitted work.

                [*]

                A.R. and E.P. share first authorship of this work.

                Article
                Publisher ID: 2023.10.FOCVID23135
                DOI: 10.3171/2023.10.FOCVID23135
                PMC ID: 10821639
                PubMed ID: 38283811
                SO-VID: 3225795d-7b19-49d7-937a-534b7377a1f5
                Copyright © © 2024, The Authors
                License:

                This is an open access article distributed under the CC BY license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 15 August 2023
                Date accepted : 20 October 2023
                Page count
                Figures: 0, Tables: 0, References: 5, Pages: 3
                Categories
                Subject: Article

                Keywords: exoscope,total temporal bone resection,lateral temporal bone resection
                Data availability:
                Keywords: exoscope, total temporal bone resection, lateral temporal bone resection

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