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Abstract：
OBJECTIVE: Superficial temporal artery to middle cerebral artery (STA-MCA) direct bypass surgery is the most common surgical procedure to treat moyamoya disease (MMD). Here, we aim to compare the performance of the 3D exoscope in bypass surgery with the gold standard operative microscope.
METHODS: All direct STA-MCA bypass procedures performed at a single university hospital for MMD between 2015 and 2023 were considered for inclusion. Data were retrospectively collected from patient files and surgical video material. From 2020 onwards, bypass procedures were exclusively performed using a digital three-dimensional exoscope as visualization device. Results were compared with a microsurgical bypass control group (2015-2019). The primary endpoint was defined as total duration of surgery, duration of completing the vascular anastomosis (ischemia time), bypass patency, number of stiches to perform the anastomosis, added stiches after leakage testing of the anastomosis and the Glasgow outcome scale (GOS) at last follow-up as secondary outcome parameter.
RESULTS: A total of 16 consecutive moyamoya patients underwent 21 STA-MCA bypass procedures. Thereof, six patients were operated using a microscope and ten patients using an exoscope (ORBEYE® n = 1; AEOS® n = 9). Total duration of surgery was comparable between devices (microscope: 313 min. ± 116 vs. exoscope: 279 min. ± 42; p = 0.647). Ischemia time also proved similar between groups (microscope: 43 min. ± 19 vs. exoscope: 41 min. ± 7; p = 0.701). No differences were noted in bypass patency rates. The number of stiches per anastomosis was similar between visualization devices (microscope: 17 ± 4 vs. exoscope: 17 ± 2; p = 0.887). In contrast, more additional stiches were needed in microscopic anastomoses after leakage testing the bypass (p = 0.035).
CONCLUSIONS: Taking into account the small sample size, end-to-side bypass surgery for moyamoya disease using a foot switch-operated 3D exoscope was not associated with more complications and led to comparable clinical and radiological results as microscopic bypass surgery.
METHODS: All direct STA-MCA bypass procedures performed at a single university hospital for MMD between 2015 and 2023 were considered for inclusion. Data were retrospectively collected from patient files and surgical video material. From 2020 onwards, bypass procedures were exclusively performed using a digital three-dimensional exoscope as visualization device. Results were compared with a microsurgical bypass control group (2015-2019). The primary endpoint was defined as total duration of surgery, duration of completing the vascular anastomosis (ischemia time), bypass patency, number of stiches to perform the anastomosis, added stiches after leakage testing of the anastomosis and the Glasgow outcome scale (GOS) at last follow-up as secondary outcome parameter.
RESULTS: A total of 16 consecutive moyamoya patients underwent 21 STA-MCA bypass procedures. Thereof, six patients were operated using a microscope and ten patients using an exoscope (ORBEYE® n = 1; AEOS® n = 9). Total duration of surgery was comparable between devices (microscope: 313 min. ± 116 vs. exoscope: 279 min. ± 42; p = 0.647). Ischemia time also proved similar between groups (microscope: 43 min. ± 19 vs. exoscope: 41 min. ± 7; p = 0.701). No differences were noted in bypass patency rates. The number of stiches per anastomosis was similar between visualization devices (microscope: 17 ± 4 vs. exoscope: 17 ± 2; p = 0.887). In contrast, more additional stiches were needed in microscopic anastomoses after leakage testing the bypass (p = 0.035).
CONCLUSIONS: Taking into account the small sample size, end-to-side bypass surgery for moyamoya disease using a foot switch-operated 3D exoscope was not associated with more complications and led to comparable clinical and radiological results as microscopic bypass surgery.
摘要：
目的：颞浅动脉至大脑中动脉（STA-MCA）直接搭桥手术是治疗烟雾病（MMD）最常见的手术方法。这里,我们的目的是比较3D外镜在旁路手术中的性能与金标准手术显微镜。
方法：考虑纳入2015年至2023年在一家大学医院进行的所有直接STA-MCA旁路手术。数据是从患者档案和手术视频材料中回顾性收集的。从2020年起,旁路手术仅使用数字三维外镜作为可视化设备进行.结果与显微外科搭桥对照组（2015-2019）进行比较。主要终点定义为手术的总持续时间，完成血管吻合的持续时间（缺血时间），旁路通畅,进行吻合的缝线数量，在最后一次随访时,在吻合口渗漏试验和格拉斯哥结局量表(GOS)后增加了一些指标作为次要结局参数.
结果：共有16名连续烟雾患者接受了21个STA-MCA旁路手术。其中，6例患者使用显微镜进行手术,10例患者使用外镜进行手术(ORBEYE®n=1;AEOS®n=9).手术的总持续时间在设备之间相当（显微镜：313分钟。±116vs.外镜：279分钟。±42；p=0.647）。缺血时间也证明组间相似（显微镜：43分钟。±19vs.外镜：41分钟。±7；p=0.701）。旁路通畅率没有差异。在可视化设备之间，每次吻合的针数相似（显微镜：17±4vs.外镜：17±2；p=0.887）。相比之下,在旁路泄漏测试后,在显微吻合中需要更多额外的缝合(p=0.035).
结论：考虑到样本量小，使用脚踏开关式3D外镜对烟雾病进行端侧搭桥手术与更多并发症无关,并导致与显微搭桥手术相当的临床和放射学结果.
方法：考虑纳入2015年至2023年在一家大学医院进行的所有直接STA-MCA旁路手术。数据是从患者档案和手术视频材料中回顾性收集的。从2020年起,旁路手术仅使用数字三维外镜作为可视化设备进行.结果与显微外科搭桥对照组（2015-2019）进行比较。主要终点定义为手术的总持续时间，完成血管吻合的持续时间（缺血时间），旁路通畅,进行吻合的缝线数量，在最后一次随访时,在吻合口渗漏试验和格拉斯哥结局量表(GOS)后增加了一些指标作为次要结局参数.
结果：共有16名连续烟雾患者接受了21个STA-MCA旁路手术。其中，6例患者使用显微镜进行手术,10例患者使用外镜进行手术(ORBEYE®n=1;AEOS®n=9).手术的总持续时间在设备之间相当（显微镜：313分钟。±116vs.外镜：279分钟。±42；p=0.647）。缺血时间也证明组间相似（显微镜：43分钟。±19vs.外镜：41分钟。±7；p=0.701）。旁路通畅率没有差异。在可视化设备之间，每次吻合的针数相似（显微镜：17±4vs.外镜：17±2；p=0.887）。相比之下,在旁路泄漏测试后,在显微吻合中需要更多额外的缝合(p=0.035).
结论：考虑到样本量小，使用脚踏开关式3D外镜对烟雾病进行端侧搭桥手术与更多并发症无关,并导致与显微搭桥手术相当的临床和放射学结果.
