• Abdullah M Abunimer, Hussam Abou-Al-Shaar, Timothy G White, Jung Park, and Michael Schulder.
• Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar.
• World Neurosurg. 2022 Feb 1; 158: e231-e236.

BackgroundThe use of an exoscope in neurosurgical procedures has been proposed to improve ergonomics and to overcome the limitations faced with the microscope and endoscope. However, there remains scarcity of data regarding its surgical utility and outcomes. The authors report their experience and evaluate the surgical outcomes using a high-definition 2-dimensional (HD-2D) stereotactic exoscope in the management of various cranial and spinal pathologies.MethodsWe retrospectively identified patients who underwent neurosurgical procedures using the HD-2D stereotactic exoscope over a 2-year period. Demographic and surgical characteristics were analyzed.ResultsTwenty-nine patients (70.7%) underwent cranial surgery, and 12 patients (29.3%) underwent spine surgery. In patients having brain tumor removal, gross total resection was achieved in 18 patients (62.1%), with an overall average pathology size of 4.2 ± 1.6 cm. Adjuvant utilization of the microscope was required in 4 cranial cases (13.8%) to ensure optimal resection rate. Three complications and 2 mortalities were encountered in the cranial group during a mean follow-up of 4.6 ± 3.3 months. In the spinal cohort, the HD-2D stereotactic exoscope was used for anterior decompression and fusion (n = 5), posterior decompression and fusion (n = 5), and microdiskectomy and foraminotomy (n = 2). No complications were encountered in the spinal group during a mean follow-up of 3.8 ± 2.7 months.ConclusionsThe HD-2D stereotactic exoscope offers a wider field of view, greater mean focal distance, enhanced ergonomics, and immersive stereotactic visual experience. The lack of stereopsis remains the principal limitation of its use, and further optimization of surgical outcomes might be achieved with newer 3-dimensional models.Copyright © 2021 Elsevier Inc. All rights reserved.

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