Related Experiment Video
Updated: Sep 16, 2025
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Educational Impact of an Annotation System Integrated with an Exoscope for Cerebral Aneurysm Surgery: Case
Yoji Tanaka1, Motoki Inaji2, Daisu Abe2
1Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan. tanaka.nsrg@tmd.ac.jp.
Purpose:
The three-dimensional (3D) exoscope has been reported to have better image quality, ergonomics, and educational outcomes than a microscope. However, whether the exoscope can improve communication between the main surgeon and the mentor remains unclear. This chapter introduces our experience with using an exoscope and an annotation system for surgical education during a left middle cerebral aneurysm surgery in a 63-year-old woman.
Methods:
We used an annotation system integrated with a 3D exoscope during aneurysm surgery. The mentor provided instruction by using the annotation system to write information on the surgical monitor.
Results:
The aneurysmal neck was broad and required two clips to achieve complete clipping. On a monitor, the mentor drew instructions for inserting the clips. The surgeon successfully accomplished the clipping as instructed. Intraoperative indocyanine green angiography revealed the complete occlusion of the aneurysm. The patient had no postoperative neurological deficit.
Conclusion:
A new system using an annotation system integrated with an exoscope for surgical education was introduced and applied to an aneurysm clipping surgery. This system is expected to improve communication between surgeons and mentors and improve surgical safety.
