Craniotomy Complexity and Outcomes in Exoscope-Assisted Cranial Surgery: A Single-Center Retrospective Analysis

Objective: The exoscope is an emerging digital visualization technology in neurosurgery that provides high-definition 3D 4k magnified views of the surgical field on external monitors, promoting improved ergonomics and enhanced team involvement. This study presents a single center experience of 26 patients undergoing brain tumor resection using the Olympus Orbeye exoscope with surgical approaches of different complexities and provides a review of the current literature on exoscopic adoption in neurosurgical oncology. Methods: We retrospectively reviewed clinical, surgical, and outcome data from a consecutive series of 26 patients who underwent brain tumor resection with the ORBEYE exoscope. Metrics analyzed included extent of resection, surgical technique, and complications in two different complex scenarios: superficial and deep lesions. Results: In our institutional case series, use of the exoscope enabled gross total or subtotal resection in all the patients, with a surgical complication rate comparable to that reported for operative microscopes (14.3-23.1%), which was stated to be non-significant and independently correlated to the use of the exoscope. No device-related adverse events were observed, and postoperative neurological outcomes were in line with the overall survival pathological examination of the lesion treated. Conclusions: In this cohort, the exoscope enabled the safe and effective resection of superficial and deep lesions with outcomes comparable to those historically reported with operating microscopes. Gross total resection rates were high in the superficial cohort and substantially higher than in the deep cohort, while complication rates did not differ significantly between groups. Future prospective studies with long-term follow-up are needed to assess oncological outcomes and define the optimal role of exoscopic technology in neurosurgical oncology.