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

## TL;DR

This study examines the use of an exoscope in brain tumor surgery, finding it safe and effective for resecting both shallow and deep tumors with outcomes similar to traditional microscopes.

## Contribution

The paper provides a novel single-center retrospective analysis of exoscope use in cranial surgery, comparing outcomes across surgical complexities.

## Key findings

- Exoscope enabled gross total or subtotal resection in all 26 patients with complication rates comparable to traditional microscopes.
- Gross total resection rates were higher for superficial lesions compared to deep ones, though complication rates did not differ significantly.
- Postoperative neurological outcomes and survival were consistent with pathological findings, with no device-related adverse events observed.

## Abstract

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.