Craniotomy Complexity and Surgical Outcomes in Brain Tumor Resection Applying Exoscope Technology: A Single Center Retrospective Analysis

Objective: The exoscope is an emerging digital visualization technology in neurosurgery that provides high-definition 3D 4k magnified views of the surgical field on external monitors, promoting improved ergonomics and enhanced team involvement. This study presents a single center experience of 26 patients undergoing brain tumor resection using the Olympus Orbeye exoscope with different complexity surgical approaches and provides a review of current literature on exoscopic adoption in neurosurgical oncology. Methods: We retrospectively reviewed clinical, surgical and outcome data from a consecutive series of 26 patients who underwent brain tumor resection with the ORBEYE exoscope. Metrics analyzed included extent of resection, surgical technique and complications in 2 different complex scenarios: superficial and deep lesions. Results: In our institutional case series, use of the exoscope enabled the gross total or subtotal resection in all the patients, with a surgical complication rate comparable to that reported for operative microscopes (14.3–23.1%), which was state to be non-significant and independently correlated to the use of the exoscope. No device-related adverse events were observed, and postoperative neurological outcomes were in line with the overall survival pathological examination of the lesion treated. Conclusion: Integration of the exoscope into brain tumor surgery is both feasible and safe, offering high-quality visualization and ergonomics helping the surgeon in complex surgical approaches. Systematic review of published literature supports these findings and highlights the exoscope’s utility in education and teamwork. Future prospective studies with long-term follow-up are needed to assess oncological outcomes and define the optimal role of exoscopic technology in neurosurgical oncology.