• Edoardo Porto, J Manuel Revuelta-Barbero, Roberto M Soriano, Hanyao Sun, C Arturo Solares, Douglas E Mattox, Gustavo Pradilla, Esther Vivas, and Tomas Garzon-Muvdi.
• Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
• World Neurosurg. 2022 Dec 1; 168: 103110103-110.

BackgroundRecent studies highlighted how exoscopes may be employed to approach the lateral skull base. The use of exoscope-assisted procedures to repair middle cranial fossa (MCF) defects has not been fully explored. The surgical microscope in the same circumstances has been associated with relevant limitations, such as its physical obstruction, among others. The aim of this study was to present a proof of concept of exoscope-assisted surgery for MCF defects.MethodsA detailed step-by-step MCF approach was performed on 2 alcohol-preserved, latex-injected cadaveric specimens under exoscopic magnification. An illustrative clinical case of encephalocele secondary to a spontaneous tegmen tympani defect repaired via an exoscope-assisted MCF approach was presented.ResultsThe most common sites of MCF defects, the tegmen tympani and the arcuate eminence, were successfully exposed under exoscopic magnification. Dissection was easily performed; no damage to the dura mater or to vascular or neural structures occurred. In the clinical case, the exoscope-assisted technique demonstrated adequate maneuverability and magnification quality. After localization, the encephalocele was resected, and the MCF defect was repaired. The surgeon's position was comfortable, and operative time was not prolonged.ConclusionsThe exoscope allows adequate exposure of the MCF floor with identification and preservation of key anatomical structures. The exoscope represents a valuable alternative to the microscope in reconstruction of MCF defects, offering high-quality magnification and proven maneuverability.Copyright © 2022 Elsevier Inc. All rights reserved.

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