OBJECTIVE 3D exoscopic visualization in neurosurgical procedures is of interest for several reasons. The VITOM-3D exoscopic system is cheaper compared to the operating microscope (OM) and offers each person involved in the procedure the same image of the operative field. Little is known of limitations of this visualization technique. PATIENTS AND METHODS Prospectively, a consecutive series 34 procedures were assessed with focus on the following aspects: intraoperative limitation and the cause for a switch to the OM or endoscopy. A standardized questionnaire was answered by each individual involved in the procedure to assess the image quality, illumination, and magnification of the operative field. Intraoperative video recording and pre- and postoperative MRI and CT-scan were analyzed to assess the dimensions of the surgical approach. RESULTS Sixteen cranial and 18 spinal procedures (10 intra-axial, 6 extra-axial, 6 cervical, and 12 lumbar) were performed by seven neurosurgical attendings, twelve residents and twelve scrub nurses who all completed a standardized questionnaire after each procedure. Handling and identification of anatomical structures was rated equal or superior to the OM in 62 % and over 80 % of cases, respectively. The illumination and magnification of the operative field on the surface was rate in equal od superior in all cases and on the depth it was rated inferior to the OM over 60 % of cases. In one spinal and five cranial procedures a switch to the OM or endoscope were performed for the following reasons: poor illumination (4 cases), tissue identification (1 case), need for fluorescence imaging (1 case). CONCLUSION 3D exoscopic visualization using the VITOM-3D is best suited for spinal procedures and for extra-axial cranial procedures. In case of small approach dimensions, the illumination and magnification of the depth of the operative field is rated inferior to the OM which resulted in difficulty of tissue identification and a switch to the OM.

中文翻译：

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在颅神经外科和脊髓神经外科中使用 VITOM-3D 进行 3D 外窥镜可视化。有哪些限制？

出于多种原因，神经外科手术中的目标 3D 外窥镜可视化令人感兴趣。与手术显微镜 (OM) 相比，VITOM-3D 外窥镜系统更便宜，并为参与手术的每个人提供相同的手术视野图像。人们对这种可视化技术的局限性知之甚少。患者和方法 前瞻性地对连续的 34 个系列程序进行了评估，重点关注以下方面：术中限制和切换到 OM 或内窥镜检查的原因。参与手术的每个人都回答了一份标准化的问卷，以评估手术视野的图像质量、照明和放大率。分析术中视频记录以及术前和术后 MRI 和 CT 扫描，以评估手术方法的尺寸。结果 7 名神经外科主治医师、12 名住院医师和 12 名擦洗护士进行了 16 次颅骨手术和 18 次脊柱手术（10 次轴内手术、6 次轴外手术、6 次颈椎手术和 12 次腰椎手术），他们在每次手术后都完成了标准化的问卷调查。解剖结构的处理和识别分别在 62% 和 80% 以上的情况下被评为等于或优于 OM。手术视野在表面的照明和放大率在所有情况下都是相同的，并且在深度上它被评为低于 OM 超过 60% 的情况。在一次脊柱手术和五次颅骨手术中，由于以下原因而切换到 OM 或内窥镜：照明不佳（4 例）、组织识别（1 例）、需要荧光成像（1 例）。结论 使用 VITOM-3D 的 3D 外窥镜可视化最适合脊柱手术和轴外颅骨手术。在小方法尺寸的情况下，手术视野深度的照明和放大率低于 OM，导致组织识别困难和切换到 OM。