Exoscopic Keyhole Clipping of Unruptured Middle Cerebral Artery Aneurysms Using Multiple 4K 3-dimensional Monitors

Area of Science:

• Neurosurgery
• Minimally Invasive Techniques
• Medical Technology

Background:

• Traditional surgical microscopy for aneurysm clipping presents visual limitations.
• Advancements in exoscopic technology offer potential for enhanced visualization in neurosurgery.

Purpose of the Study:

• To evaluate the safety and efficacy of exoscopic keyhole clipping for unruptured middle cerebral artery aneurysms.
• To compare exoscopic clipping with traditional microscopic techniques.

Main Methods:

• Nineteen patients underwent exoscopic keyhole clipping using the ORBEYE exoscope and multiple 4K 3D monitors.
• A historical control group of 21 patients treated with surgical microscopy was used for comparison.
• Key outcomes included procedure success, aneurysm diameter, craniotomy size, procedure duration, blood loss, and indocyanine green dose.

Main Results:

• All exoscope procedures were successful.
• No significant differences were observed in aneurysm diameter, craniotomy size, procedure duration, or blood loss between groups.
• The exoscope group showed a significantly lower mean indocyanine green dose.

Conclusions:

• Exoscopic keyhole clipping for unruptured middle cerebral artery aneurysms is safe, efficient, and comparable to microscopic clipping.
• The use of an exoscope with multiple 4K 3D monitors presents no major barriers for neurosurgeons transitioning from microscopy.