• World Neurosurg · Jun 2024

    Review Case Reports

    Preliminary experience on 3D-exoscopic untethering of a type II diastematomyelia: technical note and review of literature.

    • Cedric Barillot, Sergio Capelli, Immacolata Mazzetto, Antonio Leocata, Fabio Pozzi, Gianluca Agresta, and Davide Locatelli.
    • Division of Neurosurgery, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, Varese, Italy. Electronic address: c.barillot@unibs.it.
    • World Neurosurg. 2024 Jun 1; 186: e1e6e1-e6.

    ObjectiveTo describe the use of a high-definition 3-dimensional (3D) exoscope (VITOM 3D exoscope; KARL STORZ GmbH) for the neurosurgical treatment of a rare pediatric disease, type II diastematomyelia with associated tethered cord.MethodsA 13-year-old girl who presented with diastematomyelia type II with a tethered cord was surgically treated with the aid of a high-definition 3D exoscope, with a third operator moving and pivoting its arm. Intraoperative monitoring and mapping were arranged. The surgery required a bilateral access to address both the split cord malformation and the tethering of the filum terminale. The filum terminale was identified and cut, and the connective fibrovascular tissue separating the 2 medullary halves was unraveled. These steps were performed with no changes of intraoperative monitoring. Pertinent literature was addressed carefully.ResultsThe surgery was successful, and the patient was discharged home on the eleventh postoperative day without any complications. The 3-month postoperative magnetic resonance imaging scan demonstrated regular surgical outcomes; no dynamic motor disturbances were reported. To our knowledge, this is the first spinal congenital malformation treated with the use of a 3D exoscope.ConclusionsThe use of 3D exoscope is advancing in spinal surgery, as it provides magnification, stereopsis, lighting, and definition comparable with the operating microscope; the addition of a third operator simplified the operations of moving around the arm, releasing these burdens for the surgeons. Our preliminary experience proved that the use of a 3D exoscope is feasible and safe for the surgical management of a type II diastematomyelia with tethered cord.Copyright © 2024 Elsevier Inc. All rights reserved.

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