The exoscope paradigm shift in neurosurgery

Abstract

The surgical microscope has been the gold‒standard visual equipment for neurosurgical procedures since its introduction in the 1960s. Although it undoubtedly has made enormous contribution to the field, this medical device still offers room for improvement. In particular, physical size and weight restrict the relationship between surgeons and patient positions. The exoscope is a newly developed medical tool for microneurosurgery. The fundamental concept of this device is to provide excellent ergonomics during neu-rosurgical procedures while preserving the numerous advantages that surgical microscopes provide to surgeons. It is composed of a small stereo camera and a 4K three‒dimensional large display. Although its clinical impact remains debatable, this device may completely replace surgical microscopes in the coming years. The exoscope enables： 1．shallow‒angle surgical approaches without compromising the surgeon posture； 2．assistance in deep‒seated surgical fields； 3．the collection of three‒dimensional surgical field data with quantitative measurement of surgical maneuvers. This review article provides an overview of the advantages mentioned above using clinical cases oper-ated with exoscope assistance to help understand its clinical and technological impact on neurological sur-gery.