Our Summary

This study is about comparing two types of tools that doctors use during brain and spinal surgeries - the VITOM 2D exoscope and the KINEVO microscope. These tools help surgeons see better during operations. The exoscope is a newer tool and is less expensive than the microscope. The researchers wanted to see if the exoscope is as good as, or better than, the microscope.

They used the exoscope in 9 brain and 5 spinal surgeries on children, and the microscope in 12 brain and 6 spinal surgeries on children. All the surgeries were done by the same experienced surgeon. The researchers looked at things like how clear the images were, how well lit the area was, how much of the area could be seen, and how much the area could be magnified. They also looked at how comfortable the surgeon was using the tools.

They found that in 7 out of 9 brain surgeries, the surgeon had to switch from the exoscope to the microscope because the images weren’t sharp enough. The exoscope also didn’t show where bleeding was coming from very well. However, the exoscope did work fine for all 5 spinal surgeries, and for 2 brain surgeries where the tumors were closer to the surface. The surgeon found the exoscope easier to use and to switch to looking without the tool, but the microscope showed a better view, was better lit, and was easier to use overall.

The conclusion was that the exoscope works best for spinal surgeries and for brain surgeries where the tumor is closer to the surface. But, the exoscope needs improvements, especially with the optics, before it can replace the microscope.

FAQs

  1. What is the 2D VITOM exoscope and how does it compare to a traditional operative microscope in neurosurgery?
  2. What are the advantages and disadvantages of using the 2D VITOM exoscope in cranial and spinal pediatric surgeries?
  3. What improvements are suggested for the 2D VITOM exoscope to become a viable substitute for the operative microscope?

Doctor’s Tip

A doctor may advise a patient undergoing brain surgery that the use of a microscope may provide better image quality, illumination, field of view, and magnification of the operative field compared to a 2D VITOM exoscope. It is important for the surgeon to have clear and detailed visibility during the surgery to ensure successful outcomes. Additionally, the doctor may mention that the use of a microscope may offer superior user-friendliness and overall performance compared to an exoscope.

Suitable For

Patients who may be recommended for brain surgery include those with:

  1. Brain tumors
  2. Epilepsy that cannot be controlled with medication
  3. Aneurysms or other vascular malformations in the brain
  4. Traumatic brain injuries
  5. Hydrocephalus (build-up of fluid in the brain)
  6. Parkinson’s disease or other movement disorders
  7. Chiari malformation
  8. Trigeminal neuralgia
  9. Brain abscesses
  10. Spinal cord tumors or malformations

It is important for patients to undergo a thorough evaluation by a neurosurgeon to determine if brain surgery is the best treatment option for their specific condition.

Timeline

  • Before brain surgery: The patient undergoes various medical tests and imaging studies to determine the need for surgery and to plan the procedure. The patient also meets with the neurosurgeon to discuss the risks and benefits of the surgery and to address any concerns or questions.

  • Day of surgery: The patient is admitted to the hospital and prepared for surgery. Anesthesia is administered, and the surgical team sets up the operating room with the necessary equipment. The neurosurgeon performs the surgery, using either a microscope or an exoscope like VITOM for visualization.

  • After brain surgery: The patient is taken to the recovery room and monitored closely for any complications. Depending on the type of surgery, the patient may stay in the hospital for a few days to a week for observation and rehabilitation. Follow-up appointments are scheduled to monitor the patient’s progress and address any concerns. Rehabilitation therapy may be recommended to help the patient regain strength and function.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with brain surgery using the VITOM 2D exoscope compared to traditional microscope?

  2. How does the image quality and magnification of the operative field compare between the VITOM 2D exoscope and microscope?

  3. What is the field of view like when using the VITOM 2D exoscope compared to a microscope during brain surgery?

  4. How does the illumination of the surgical field differ between the VITOM 2D exoscope and microscope?

  5. What is the surgeon’s experience and comfort level using the VITOM 2D exoscope compared to a microscope during brain surgery?

  6. In what types of brain surgeries is the VITOM 2D exoscope most suitable and when would a traditional microscope be preferred?

  7. Are there any specific modifications or improvements needed for the VITOM 2D exoscope to potentially replace the microscope in certain neurosurgery procedures?

  8. How does the ergonomics and ease of use differ between the VITOM 2D exoscope and microscope during brain surgery?

  9. Are there any specific training or learning curves associated with using the VITOM 2D exoscope for brain surgery that patients should be aware of?

  10. What are the long-term outcomes and success rates of brain surgeries performed using the VITOM 2D exoscope compared to traditional microscope?

Reference

Authors: Das AK, Mani SK, Singh SK, Kumar S. Journal: Childs Nerv Syst. 2022 Nov;38(11):2171-2177. doi: 10.1007/s00381-022-05636-y. Epub 2022 Aug 9. PMID: 35943568