• Takamitsu Iwata, Shingo Toyota, Akira Kudo, Kanji Nakagawa, Takeshi Shimizu, Tomoaki Murakami, Kanji Mori, Takuyu Taki, and Haruhiko Kishima.
• Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
• World Neurosurg. 2020 Jun 1; 138: 178-181.

BackgroundOne of the merits of exoscopes, including ORBEYE, is that they are superior to a microscope in terms of ergonomic features. We report a case of dural arteriovenous fistula (dAVF) that was cured by direct surgery using the ergonomic advantages of ORBEYE.Case DescriptionA 78-year-old man was found to have dAVF of the anterior cranial fossa incidentally. We performed direct surgery via bifrontal craniotomy. Because the frontal sinus was large, we reserved the frontal bone-like eaves in order not to open the frontal sinus. The vertex of his head was sufficiently down to shift the frontal lobe downward with gravity. During surgery, we set the angle of the operative visual axis of ORBEYE approximately horizontal to avoid the reserved frontal bone. We performed a stable operation using ORBEYE in a comfortable posture.ConclusionsORBEYE facilitates ergonomic microsurgery, even under the eaves, with the angle of the operative visual axis approximately horizontal using gravity.Copyright © 2020 Elsevier Inc. All rights reserved.

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