Three-Dimensional Exoscopic Temporal Bone Resections for Advanced Head and Neck Cancer

Objectives  The three-dimensional (3D) exoscope has several advantages over the operative microscope (OM) but has not been extensively reported for its use in malignant temporal bone resections (TBR). We sought to demonstrate the feasibility of performing TBR, both lateral (LTBR) and subtotal (STBR), using the 3D exoscope for head and neck cancers. Design  present study is a retrospective chart review from August 2016 until August 2019. Setting  The study was conducted at a tertiary care center. Participants  Patients were undergoing TBR with the Karl Storz VITOM 3D exoscope. Main Outcome Measures  Demographics, tumor and surgical characteristics, patient outcomes were the primary measurements of this study. Results  Fifty-five patients underwent 3D exoscopic TBR from 2016 through 2019 of which 18% ( n  = 10) underwent STBR. The 3D exoscope was used uninterruptedly in all procedures with no intraoperative complications. Most tumors were primarily T3 (42%, n  = 23) or T4 (55%, n  = 30) and of cutaneous (62%, n  = 34) and parotid (27%, n  = 15) origin. These TBR were often accompanied by infratemporal fossa resections (87%, n  = 48), auriculectomies (47%, n  = 26), mandibulectomies (53%, n  = 29), and parotidectomies (96%, n  = 53). On final pathology, 24% ( n  = 13) had microscopically positive margins. Over the study period, 20% ( n  = 11) of patients had recurrences with a median recurrence time of 5 months (range: 2-30 months). Conclusion  In the largest case series of LTBR and STBR under exclusive 3D exoscopic visualization to date, we demonstrate the 3D exoscope is a feasible alternative to the operative microscope for LTBR and STBR. While oncologic outcomes remain to be clarified, it carries significant potential for use in complex oncologic procedures.