Abstract
The favorable outcome generally associated with spinal meningioma surgery is the result of the continuing refinement of the surgical technique, the use of intraoperative neuromonitoring, and a better understanding of the tumor biological behavior. Among all the technological advancements, visualization tools are the keys to any successful surgical procedure. The operating microscope is the gold standard in all neurosurgical procedures. In recent years, high-definition exoscope systems have entered the field of neurosurgery, as another tool in the armamentarium of the contemporary neurosurgeon. After initial experiences and technical improvements, the exoscope has proven to be best suited for spinal procedures. This study aims to briefly review the exoscope journey in neurosurgery, with a special focus on spinal meningioma surgery. Benefits and limitations are analyzed and an illustrative case is reported. Spinal meningiomas removal under exoscope visualization has proven to be feasible, efficient, and safe. Indication for the use of the exoscope greatly depends on meningioma size, consistency, relationship to surrounding neurovascular structures, and the surgeon’s experience. Switching to the operating microscope, if deemed safer, should always be considered.
Highlights
Spinal meningiomas are intradural extra-medullary lesions that arise from meningothelial arachnoid cells within the spinal dura mater
Spinal meningiomas have shown to be less likely to recur than their intracranial analogs, with the majority of series reporting no significant difference in recurrence rates between Simpson grade I and grade II resections[5]
The safety of meningiomas surgery is increased by the use of multimodal neuromonitoring: somatosensory-evoked potentials, motor evoked potentials, and D-waves provide the opportunity to assess the functional integrity of the spinal cord during surgery, bearing the risk of neurological complications
Summary
Spinal meningiomas are intradural extra-medullary lesions that arise from meningothelial arachnoid cells within the spinal dura mater. Initial impressions were that the most obvious and clinically relevant benefits are related to working ergonomics (intuitive operating room setup, instrument handling, and surgeons’ comfort) and trainees’ learning experience Some disadvantages such as headache, dizziness, and nausea due to wearing polarized glasses, the use of two monitors in selected cases were the surgeon and the assistant were positioned on the opposite side of the patient’s body, and the inability to rotate the onscreen picture has been reported as well[39,40,41]. Along with the definition of advantages and disadvantages of the exoscope over the operating microscope or endoscope, the increased experience brought to light on the surgical setting in which the use of Vitom3D could be best indicated. The most frequently reported location for spinal meningiomas is the thoracic spine (67%-84%),
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