Exoscopic Visualization for Transorbital Surgery: Preliminary Anatomical and Clinical Validation Study

Area of Science:

• Neurosurgery
• Surgical Visualization Technology

Background:

• The endoscopic transorbital approach (ETOA) is a minimally invasive technique for lateral skull base access.
• Recent advancements explore exoscopic visualization as an alternative to traditional endoscopic methods in ETOA.

Purpose of the Study:

• To evaluate the effectiveness of exoscopic visualization compared to endoscopic visualization in ETOA.
• To assess the impact of exoscopic use across different surgical phases: skin, orbital, and intracranial.

Main Methods:

• Eight cadaveric specimens were dissected using four different visualization strategies: pure endoscopic ETOA, combined exoscopic/endoscopic ETOA (partial or extensive exoscope use), and pure exoscopic ETOA.
• Surgeons rated operative comfort, maneuverability, and image quality.
• CT scans were used for volumetric analysis of the surgical cavity; operative times were recorded.

Main Results:

• Exoscopic visualization significantly improved working space and access during the skin and orbital phases.
• Endoscopic visualization offered superior clarity and magnification for deep orbital structures.
• Combined approaches resulted in shorter operative times and higher surgeon satisfaction ratings.

Conclusions:

• The exoscope is a valuable tool for transorbital surgery, especially for superficial dissection.
• Endoscopic visualization remains indispensable for the intracranial phase of ETOA.
• The orbital phase can be effectively managed by either technique, with combined approaches offering practical advantages.