Preliminary experience with VITOM 3D exoscope during microsurgical treatment of cerebral aneurysms

The use of a digital three-dimensional (3D) exoscope system in neurosurgery is increasing as an alternative to the operative microscope due to its similar visual fidelity but superior ergonomics. However, publications on cerebral aneurysms treated with this are scarce.

Clinical information, surgical records and, imaging of patients with cerebral aneurysms undergoing surgery by a single surgeon, from December 2023 to March 2025, using the VITOM 3D as a vision/magnification method exclusively, is analyzed. Postoperative follow-up included angio-CT scan. Descriptive statistics and data relating to operative time and complications were analyzed. An extensive discussion regarding other authors' experience using 4K 3D exoscopes in microsurgical clipping of cerebral aneurysms was performed and compared with the present series.

Eighty-eight patients with 107 cerebral aneurysms underwent surgery. Most patients were female (65.9%), with a mean age of 52.6 (±13.6) years. Grades I-III WFNS score was seen in 74 (84.1%) patients, with 14 (15.9%) having grade IV. Ruptured aneurysm rate was 94.3%, but up to 14.9% associated unruptured aneurysms were recorded. Complications rate was 9.1%. A favorable outcome was observed in 83.0% of patients based on modified Rankin Scale score at 30 days.

VITOM 3D exoscope is a valid alternative to the surgical microscope, since it offers comparable visualization but superior ergonomics, at a lower cost. Randomized comparative studies with a larger series of cases should be carried out to increase the level of evidence.