Off-axis microsurgical training using combined exoscopy and endoscopy in a cerebral aneurysm model.

Abstract

Background

Recently, endoscopes have been increasingly used to visualize and inspect blind areas of cerebral aneurysms that are difficult to observe directly during microsurgery. Exoscopes are well suited for endoscope-assisted surgery because they provide a wide working space without the obstruction of a large microscope barrel. In addition, surgeons can view both the exoscopic and endoscopic images with minimal gaze shift.Methods

We developed cerebral aneurysm models for training in aneurysm dissection and clipping using combined exoscopic and endoscopic visualization. The main exoscopic monitor was aligned with the Sylvian fissure, and the endoscopic monitor was positioned adjacent to it. The endoscope was inserted from a different trajectory than the exoscopic surgical approach to directly visualize the posterior aspect of the aneurysm. Visualization and maneuverability were evaluated.Results

Combined exoscopic and endoscopic visualization from different viewing angles enabled dissection and clipping under direct visualization without blind manipulation. However, performing dissection and clipping under endoscopic visualization from an off-axis perspective required considerable practice. Surgical rehearsal using the aneurysm model was effective for understanding the technical aspects of off-axis manipulation.Conclusion

The cerebral aneurysm model enabled realistic rehearsal of combined exoscopic and endoscopic aneurysm clipping without practicing on patients. This approach may expand the potential of multi-monitor surgery integrating exoscopy and endoscopy, including future robotic neurosurgical procedures.

Preservation of Non-nidal Medial Veins During Microsurgical Resection of Cerebral Arteriovenous Malformations: Technical Considerations and Early Clinical Outcomes
Md. Moshiur Rahman, Robert Ahmed Khan, Md. Rokibul Islam +2
Cureus16 Oct 2026Peer-reviewedCC BYFull textGeneral medicineEurope PMC
Microsurgical Clipping of Middle Cerebral Artery Aneurysms: Complications and Risk Factors for Complications
Thomas Metayer, Arthur Leclerc, Alin Borha +10
World Neurosurgery22 Sep 2026Peer-reviewedLicence not stated10 citedNeurologyHAL
Microsurgical Training and Skill Acquisition: A Systematic Review and Meta-analysis.
Abigail E Elliott, Travis M Page, Corné P G Nel
Plastic and reconstructive surgery. Global open20 Oct 2026Peer-reviewedCC BY-NC-NDFull textSurgery & anaesthesiaEurope PMC
Beyond White-Light Colonoscopy: Water Exchange, Image-Enhanced Endoscopy, and Artificial Intelligence for Colorectal Neoplasia Detection—From Single Tools to Combined Strategies: A Scoping Review
Teodora Spataru, Remus Popescu, Alina Pistritu +2
Cancers5 Nov 2026Peer-reviewedCC BY 4.0OncologyCrossref
A novel mouse model of cerebral venous sinus thrombosis based on photochemical-induction combined with in situ injection
Chengbin Zhou, Huimin Jiang, Yifan Zhou +13
Journal of Cerebral Blood Flow & Metabolism16 Oct 2026Peer-reviewedLicence not statedFull textNeurologyPMC

Cite

BibTeX RIS

BibTeX

@article{tenjin2026offaxis,
  title = {{Off-axis microsurgical training using combined exoscopy and endoscopy in a cerebral aneurysm model.}},
  author = {Hiroshi Tenjin and Masahiro Nonaka},
  journal = {Surgical neurology international},
  year = {2026},
  month = oct,
  doi = {10.25259/sni_809_2026},
  url = {https://europepmc.org/article/MED/42974211},
  note = {CC BY-NC-SA},
}

RIS

TY  - JOUR
TI  - Off-axis microsurgical training using combined exoscopy and endoscopy in a cerebral aneurysm model.
AU  - Hiroshi Tenjin
AU  - Masahiro Nonaka
PY  - 2026
DA  - 2026/10/02
JO  - Surgical neurology international
DO  - 10.25259/sni_809_2026
UR  - https://europepmc.org/article/MED/42974211
AB  - Background  Recently, endoscopes have been increasingly used to visualize and inspect blind areas of cerebral aneurysms that are difficult to observe directly during microsurgery. Exoscopes are well suited for endoscope-assisted surgery because they provide a wide working space without the obstruction of a large microscope barrel. In addition, surgeons can view both the exoscopic and endoscopic images with minimal gaze shift.Methods  We developed cerebral aneurysm models for training in aneurysm dissection and clipping using combined exoscopic and endoscopic visualization. The main exoscopic monitor was aligned with the Sylvian fissure, and the endoscopic monitor was positioned adjacent to it. The endoscope was inserted from a different trajectory than the exoscopic surgical approach to directly visualize the posterior aspect of the aneurysm. Visualization and maneuverability were evaluated.Results  Combined exoscopic and endoscopic visualization from different viewing angles enabled dissection and clipping under direct visualization without blind manipulation. However, performing dissection and clipping under endoscopic visualization from an off-axis perspective required considerable practice. Surgical rehearsal using the aneurysm model was effective for understanding the technical aspects of off-axis manipulation.Conclusion  The cerebral aneurysm model enabled realistic rehearsal of combined exoscopic and endoscopic aneurysm clipping without practicing on patients. This approach may expand the potential of multi-monitor surgery integrating exoscopy and endoscopy, including future robotic neurosurgical procedures.
SN  - 2229-5097
SN  - 2152-7806
ER  -

Abstract

Related

Cite