Neurological research · 2026
Navigating the learning curve of 3D-4K exoscopic microvascular decompression: technical nuances and clinical outcomes in a 37-patient cohort.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Ichikawa-Escamilla Eduardo, Fonseca-Cosio Jesús, Castro-Prado Fernando Carlos, Espinosa-Cárdenas Raquel, Falcón-Molina Jesús Eduardo, García-Iturbide Ricardo, Chávez-Herrera Victor Ramzes, López-Valdés Julio César, López-Félix Blas E
Аннотация
BACKGROUND: The 3D-4K exoscope is an emerging digital technology in microneurosurgery. While feasible, its specific impact on surgical efficiency and diagnostic precision during microvascular decompression (MVD) remains under-researched. This study evaluates clinical outcomes, technical nuances, and the technical learning curve of 3D-4K exoscopic MVD for classic trigeminal neuralgia (TN1).
METHODS: A retrospective, longitudinal, single-center study of 37 consecutive patients with refractory TN1 was conducted in 2024. Procedures used a retrosigmoid infra-asterional approach with a robotic 3D-4K exoscope. Outcomes included pain relief, via Visual Analog Scale and Barrow Neurological Institute (BNI) Pain Scale, and surgical efficiency (total operative time). Chronological tertile analysis modeled the learning curve.
RESULTS: Mean operative time was 48 ± 13 minutes, a ~ 50% reduction compared to international benchmarks. Chronological analysis showed a significant reduction in operative duration from the early (53.2 min) to the late tertile (40.5 min) (p = 0.017) without added complications. Intraoperative 4K visualization identified additional venous conflicts in 16.2% of cases that were occult on preoperative 3T-MRI. At 6-month follow-up, successful pain relief (BNI I-II) reached 89.2%, with a significant median BNI score improvement from 4 (IQR 4-4) to 2 (IQR 1-4) (p < 0.001). The complication rate was 2.7%, consisting of a single incidental transverse sinus injury successfully managed.
CONCLUSION: 3D-4K exoscopic MVD is safe, and effective. By providing depth perception and a shared real-time visual axis, it enhances diagnostic accuracy for hidden venous conflicts, allowing a rapid technical transition without compromising traditional microscopic standards.
METHODS: A retrospective, longitudinal, single-center study of 37 consecutive patients with refractory TN1 was conducted in 2024. Procedures used a retrosigmoid infra-asterional approach with a robotic 3D-4K exoscope. Outcomes included pain relief, via Visual Analog Scale and Barrow Neurological Institute (BNI) Pain Scale, and surgical efficiency (total operative time). Chronological tertile analysis modeled the learning curve.
RESULTS: Mean operative time was 48 ± 13 minutes, a ~ 50% reduction compared to international benchmarks. Chronological analysis showed a significant reduction in operative duration from the early (53.2 min) to the late tertile (40.5 min) (p = 0.017) without added complications. Intraoperative 4K visualization identified additional venous conflicts in 16.2% of cases that were occult on preoperative 3T-MRI. At 6-month follow-up, successful pain relief (BNI I-II) reached 89.2%, with a significant median BNI score improvement from 4 (IQR 4-4) to 2 (IQR 1-4) (p < 0.001). The complication rate was 2.7%, consisting of a single incidental transverse sinus injury successfully managed.
CONCLUSION: 3D-4K exoscopic MVD is safe, and effective. By providing depth perception and a shared real-time visual axis, it enhances diagnostic accuracy for hidden venous conflicts, allowing a rapid technical transition without compromising traditional microscopic standards.