Abstract
Background: The introduction of recent innovations in the field of intraoperative imaging and neuronavigation, such as the O-arm StealthStation, allows for obtaining crucial intraoperative data by performing safer and controlled surgical procedures. As part of the improvement of surgical visual magnification and wide expansion of surgical corridors, the 3D 4 K exoscope (EX) has nowadays become an interesting and useful tool. The transoral approach (TOA) is the historical gold-standard direct microsurgical route to ventral craniovertebral junction (CVJ).
Methods: We herein report our experience, consisting of ten cases via TOA concerning the simultaneous application of an O-arm with a StealthStation navigation system (Medtronic, Memphis, TN) and an imaging system, along with the 3D 4 K exoscopes in the TOA, for the treatment of CVJ pathologies.
Results: No intraoperative neurophysiological changes or postoperative infections occurred, but neurological improvement was evident in all the patients. A complete decompression and a stable instrumentation and fusion of the CVJ were accomplished in all cases at the maximum follow-up time.
Conclusions: With EX, the role of the surgeon becomes self-sufficient with better individual surgical freedom compared to endoscopic surgery and excellent 3D vision and magnification. O-arms offer absolutely reliable intraoperative support for more-effective CVJ decompression. Nevertheless, with O-arm-assisted neuronavigation, it can be difficult to navigate C1 lateral masses and C2 isthmi, and converting 3D into 2D real-time navigation can be quite complicated. Finally, the combination of an EX with an O-arm appears more time-consuming compared to the old-fashion one.
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References
Visocchi M. Why the Craniovertebral junction? Acta Neurochir Suppl. 2019;125:3–8. https://doi.org/10.1007/978-3-319-62515-7_1.
Signorelli F, Stumpo V, Oliva A, Pascali VL, Olivi A, Visocchi M. Mastering craniovertebral junction surgical approaches: the dissection laboratory experience at the Catholic University of Rome. Acta Neurochir Suppl. 2019;125:13–5. https://doi.org/10.1007/978-3-319-62515-7_3.
Visocchi M, Iacopino G, Signorelli F, Olivi A, Maugeri R. Walk the line, the surgical hightways to the craniovertebral junction in endoscopic approaches. An historical perspective. World Neurosurg. 2018;110:544–57. https://doi.org/10.1016/j.wneu.2017.06.125.
Visocchi M, Signorelli F, Liao C, Rigante M, Paludetti G, Barbagallo G, Olivi A. Transoral versus transnasal approach for craniovertebral junction pathologies: never say never. World Neurosurg. 2018;110:592–603. https://doi.org/10.1016/j.wneu.2017.05.125.
Visocchi M, Di Martino A, Maugeri R, González Valcárcel I, Grasso V, Paludetti G. Videoassisted anterior surgical approaches to the craniocervical junction: rationale and clinical results. Eur Spine J. 2015;24:2713.
Visocchi M. Transnasal and transoral approach to the clivus and the craniovertebral junction. J Neurosurg Sci. 2019;63(5):498–500. https://doi.org/10.23736/S0390-5616.16.03114-3. Epub 2015 Mar 4.
Visocchi M, La Rocca G, Della Pepa GM, Stigliano E, Costantini A, Di Nardo F, Maira G. Anterior video-assisted approach to the craniovertebral junction: transnasal or transoral? A cadaver study. Acta Neurochir (Wien). 2014;156(2):285–92.
Visocchi M, Pappalardo G, Pileggi M, Signorelli F, Paludetti G, La Rocca G. Experimental endoscopic angular domains of transnasal and transoral routes to the craniovertebral junction: light and shade. Spine (Phila Pa 1976). 2016;41(8):669–77. https://doi.org/10.1097/BRS.0000000000001288.
Ricciardi L, Mattogno PP, Olivi A, Sturiale CL. Exoscope era: next technical and educational step in microneurosurgery. World Neurosurg. 2019;128:371–3. https://doi.org/10.1016/j.wneu.2019.05.162. Epub 2019 May 25.
Lauretti L, D'Alessandris QG, Rigante M, Ricciardi L, Mattogno PP, Olivi A. O-arm in Endonasal endoscopic Cranial Base surgery: technical note on initial feasibility. World Neurosurg. 2018;117:103–8. https://doi.org/10.1016/j.wneu.2018.06.015. Epub 2018 Jun 12.
Visocchi M, Mattogno PP, Ciappetta P, Barbagallo G, Signorelli F. Combined transoral exoscope and O-arm-assisted approach for craniovertebral junction surgery: light and shadows in single-center experience with improving technologies. J Craniovertebr Junction Spine. 2020;11(4):293–9. https://doi.org/10.4103/jcvjs.JCVJS_176_20. Epub 2020 Nov 26.
Langer DJ, White TG, Schulder M, Boockvar JA, Labib M, Lawton MT. Advances in intraoperative optics: a brief review of current exoscope platforms. Oper Neurosurg (Hagerstown). 2019;19:84.
Ricciardi L, Chaichana KL, Cardia A, Stifano V, Rossini Z, Olivi A, Sturiale CL. The exoscope in neurosurgery: an innovative “point of view”. A systematic review of the technical, surgical and educational aspects. World Neurosurg. 2019;S1878–8750(19):30080–4.
Sack J, Steinberg JA, Rennert RC, Hatefi D, Pannell JS, Levy M, Khalessi AA. Initial experience using a high-definition 3-dimensional exoscope system for microneurosurgery. Oper Neurosurg (Hagerstown). 2018;14(4):395–401.
Ariffin MHM, Ibrahim K, Baharudin A, Tamil AM. Early experience, setup, learning curve, benefits, and complications associated with exoscope and three-dimensional 4K hybrid digital visualizations in minimally invasive spine surgery. Asian Spine J. 2020;14(1):59–65.
Crosetti E, Arrigoni G, Manca A, Caracciolo A, Bertotto I, Succo G. 3D Exoscopic surgery (3Des) for Transoral Oropharyngectomy. Front Oncol. 2020;10:16.
Mamelak AN, Drazin D, Shirzadi A, Black KL, Berci G. Infratentorial supracerebellar resection of a pineal tumor using a high definition video exoscope (VITOM [1]). J Clin Neurosci. 2012;19:306–9.
Shirzadi A, Mukherjee D, Drazin DG, et al. Use of the video telescope operating monitor (VITOM) as an alternative to the operating microscope in spine surgery. Spine. 2012;37:E1517–23.
Bakhsheshian J, Strickland BA, Jackson C, et al. Multicenter investigation of channel-based subcortical trans-sulcal exoscopic resection of metastatic brain tumors: a retrospective case series. Oper Neurosurg (Hagerstown). 2019;16:159–66.
Iyer R, Chaichana KL. Minimally invasive resection of deep-seated high-grade gliomas using tubular retractors and exoscopic visualization. J Neurol Surg Part Cent Eur Neurosurg. 2018;79:330–6.
Gassie K, Wijesekera O, Chaichana KL. Minimally invasive tubular retractor-assisted biopsy and resection of subcortical intra-axial gliomas and other neoplasms. J Neurosurg Sci. 2018;62:682–9.
Oertel JM, Burkhardt BW. VITOM-3D for exoscopic neurosurgery: initial experience in cranial and spinal procedures. World Neurosurg. 2017;105:153–62.
Iwata T, Toyota S, Kudo A, Nakagawa K, Shimizu T, Murakami T, Mori K, Taki T, Kishima H. Microsurgery “under the eaves” using ORBEYE: a case of dAVF of the anterior cranial fossa. World Neurosurg. 2020;S1878-8750(20):30467–8.
Farah K, Coudert P, Graillon T, Blondel B, Dufour H. Gille 2, Fuentes S prospective comparative study in spine surgery between O-arm and Airo systems: efficacy and radiation exposure. World Neurosurg. 2018;118:e175–84.
Knafo S, Mireau E, Bennis S, Baussart B, Aldea S, Gaillard S. Operative and perioperative durations in O-arm vs C-arm fluoroscopy for lumbar instrumentation. Oper Neurosurg (Hagerstown). 2018;14(3):273–8. https://doi.org/10.1093/ons/opx142.
Visocchi M, Della Pepa GM, Doglietto F, Esposito G, La Rocca G, Massimi L. Video-assisted microsurgical transoral approach to the craniovertebral junction: personal experience in childhood. Childs Nerv Syst. 2011;27(5):825–31. Epub 2011 Jan 15.
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Visocchi, M., Signorelli, F. (2023). Combined Transoral Exoscope and OARM-Assisted Approach for Craniovertebral Junction Surgery. New Trends in an Old-Fashioned Approach. In: Visocchi, M. (eds) The Funnel: From the Skull Base to the Sacrum. Acta Neurochirurgica Supplement, vol 135. Springer, Cham. https://doi.org/10.1007/978-3-031-36084-8_37
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