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Preliminary experience with a digital robotic exoscope in cranial and spinal surgery: a review of the Synaptive Modus V system.

ABSTRACT: BACKGROUND:The microscope is the standard tool for microneurosurgery worldwide. However, the reduced illumination of the surgical field with the use of a conventional microscope during surgeries of deeply located pathologies remains unaddressed. Accordingly, different exoscope systems have recently been introduced in clinical practice. Here, we report our initial experience with the digital 2-dimensional Synaptive Modus V exoscope system in spinal and cranial surgery. METHODS:During a 2-week period between 27 September to 11 October 2018, we used the Synaptive Modus V exoscope system and performed eight neurosurgical procedures including spine (n?=?4) and cranial procedures (n?=?4). Visual quality, depth perception, complications, switching to microscope comfort level of the surgeon, and learning curve during surgery were evaluated. RESULTS:A total of eight procedures were performed, namely, vestibular schwannoma (n?=?1), skull base meningioma (n?=?1), olfactory groove meningioma (n?=?1), tentorial meningioma (n?=?1), anterior cervical discectomy (n?=?1), cervical laminectomy (n?=?1), and lumbar disc herniation (n?=?2). The overall results were comparable to the operative microscope with better visual quality and greater comfort for the surgeon. CONCLUSION:The Synaptive Modus V system is a safe tool to perform common spinal surgeries and intracranial tumor resection. Image quality is better than a microscope but with slightly less depth perception. Vigorous training in the laboratory may be helpful before clinical use.

SUBMITTER: Muhammad S

PROVIDER: S-EPMC6739455 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Preliminary experience with a digital robotic exoscope in cranial and spinal surgery: a review of the Synaptive Modus V system.

Muhammad Sajjad S Lehecka Martin M Niemelä Mika M

Acta neurochirurgica 20190522 10

<h4>Background</h4>The microscope is the standard tool for microneurosurgery worldwide. However, the reduced illumination of the surgical field with the use of a conventional microscope during surgeries of deeply located pathologies remains unaddressed. Accordingly, different exoscope systems have recently been introduced in clinical practice. Here, we report our initial experience with the digital 2-dimensional Synaptive Modus V exoscope system in spinal and cranial surgery.<h4>Methods</h4>Duri ...[more]

PMID: 31119395

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Project description:In this study, we aimed to introduce a technical note and to explore the efficacy of endoscopic surgery combined with diffusion tensor imaging (DTI) navigation for supratentorial deep cerebral cavernous malformations (CCM). A prospectively maintained database of CCM patients was reviewed to identify all CCM patients treated by endoscopic surgery. The sagittal T1-weighted anatomical magnetic resonance imaging (MRI) and DTI were acquired before surgery. Endoscopic surgery was planned and performed based on preoperative DTI images and intraoperative DTI navigation. All patients were followed up more than 6 months. Motor function deficit and modified Rankin scale (mRS) scores were documented on follow-up. A final mRS score of 0-2 was considered a good outcome, and a final mRS score >2 was considered a poor outcome. Second DTI and 3DT1 were performed at 3 months after surgery. We tracked the ipsilateral corticospinal tract (CST) on pre- and postoperative DTI images. The overall mean FA values and the number of fibers of tracked CST were compared on pre- and postoperative DTI images. Risk factors associated with motor deficits and poor outcomes were analyzed. Seven patients with deep CCM and treated by endoscopic surgery were enrolled in this study. The mean value of preoperative mRS was 1.5 ± 0.98, but that score recovered to 0.86 ± 1.22 3 months later. The mRS scores were improved significantly according to statistical analysis (p = 0.012). According to the Spearman non-parametric test, only the fiber number of ipsilateral CST on postoperative DTI was significantly associated with muscle strength 6 months after surgery (p = 0.032). Compared with preoperative CST characteristics on DTI, the change of FA value (p = 0.289) and fiber number (p = 0.289) of ipsilateral CST on postoperative DTI was not significant It meant that the CST was protected during endoscopic surgery. Endoscopic surgery based on DTI navigation might be an effective method to protect fiber tracts in supratentorial deep CCM patients and improve long-term outcomes. However, more studies and cases are needed to confirm our findings.

Dataset Information

Preliminary experience with a digital robotic exoscope in cranial and spinal surgery: a review of the Synaptive Modus V system.

Publications

Preliminary experience with a digital robotic exoscope in cranial and spinal surgery: a review of the Synaptive Modus V system.

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