TY - JOUR
T1 - A Comparative Analysis with Exoscope and Optical Microscope for Intraoperative Visualization and Surgical Workflow in 5-Aminolevulinic Acid–Guided Resection of High-Grade Gliomas
AU - Della Pepa, Giuseppe Maria
AU - Mattogno, Pier Paolo
AU - Menna, Grazia
AU - Agostini, Ludovico
AU - Olivi, Alessandro
AU - Doglietto, Francesco
PY - 2023
Y1 - 2023
N2 - Background: The exoscope has been proposed as a valid tool in 5-aminolevulinic acid–guided resection of high-grade gliomas. However, it is not clear if, beyond ergonomics, the exoscope provides a real benefit over the optical microscope (OM). The aim of this study was to compare the exoscope with the OM in terms of surgical visualization and workflow in 5-aminolevulinic acid–guided brain surgery. Methods: Surgical videos of patients diagnosed with histopathologically confirmed, Shinoda stage I, high-grade gliomas who underwent surgery in from January to April 2022 were studied. Visualization under a 5-aminolevulinic acid blue filter for vessels, parenchyma, surgical instruments, and fluorescence was categorized for both superficial and deep fields. The following data were also recorded: median number of switches between white light and blue filter, average duration per switch, and amount of work under blue filter. Results: There were 5 surgeries performed under OM guidance and 5 performed under exoscope guidance. Under a blue filter, the exoscope was significantly better than the OM in visualizing vessels, parenchyma, and surgical instruments for both superficial and deep surgical fields. The median number of switches between blue and white light was lower compared with the OM. Both median switch duration and percentage of work under the blue filter were superior when using the exoscope. Conclusions: Within the limitations of a preliminary analysis, use of the exoscope in fluorescence-guided surgery for high-grade gliomas provided significant advantages in terms of visualization of the surgical field under a blue filter and linearity of surgical flow.
AB - Background: The exoscope has been proposed as a valid tool in 5-aminolevulinic acid–guided resection of high-grade gliomas. However, it is not clear if, beyond ergonomics, the exoscope provides a real benefit over the optical microscope (OM). The aim of this study was to compare the exoscope with the OM in terms of surgical visualization and workflow in 5-aminolevulinic acid–guided brain surgery. Methods: Surgical videos of patients diagnosed with histopathologically confirmed, Shinoda stage I, high-grade gliomas who underwent surgery in from January to April 2022 were studied. Visualization under a 5-aminolevulinic acid blue filter for vessels, parenchyma, surgical instruments, and fluorescence was categorized for both superficial and deep fields. The following data were also recorded: median number of switches between white light and blue filter, average duration per switch, and amount of work under blue filter. Results: There were 5 surgeries performed under OM guidance and 5 performed under exoscope guidance. Under a blue filter, the exoscope was significantly better than the OM in visualizing vessels, parenchyma, and surgical instruments for both superficial and deep surgical fields. The median number of switches between blue and white light was lower compared with the OM. Both median switch duration and percentage of work under the blue filter were superior when using the exoscope. Conclusions: Within the limitations of a preliminary analysis, use of the exoscope in fluorescence-guided surgery for high-grade gliomas provided significant advantages in terms of visualization of the surgical field under a blue filter and linearity of surgical flow.
KW - 5-ALA
KW - Exoscope
KW - Glioblastoma
KW - High-grade glioma
KW - Optical microscope
KW - 5-ALA
KW - Exoscope
KW - Glioblastoma
KW - High-grade glioma
KW - Optical microscope
UR - http://hdl.handle.net/10807/230312
U2 - 10.1016/j.wneu.2022.11.043
DO - 10.1016/j.wneu.2022.11.043
M3 - Article
SN - 1878-8750
VL - 170
SP - 133
EP - 137
JO - World Neurosurgery
JF - World Neurosurgery
ER -