Clinical experience with a high definition exoscope system for surgery of pineal region lesions.

VITOM-90 (Karl Storz Endoscopy, Tuttlingen, Germany) is a new technology that can be used as an alternative to the operating microscope. We have found that this device substantially improves surgeon comfort during infra-tentorial supracerebellar approaches to pineal region masses, and now report our experiences. The VITOM-90 is a specially designed scope that is attached to a high definition (HD) digital camera and displayed on a HD video monitor. This system was utilized in five patients undergoing infratentorial supracerebellar approaches for pineal region lesions. Surgical outcomes and pathologies are described. The device was used by three surgeons during five procedures. Three patients underwent surgery in the sitting position and two in the modified prone (Concorde) position. Pathologies included pineocytoma, lipoma, and germinoma. Total resection was achieved in three patients and subtotal in two patients. Surgeon assessment was positive; surgeons indicated that surgery with the VITOM-90 was more comfortable than with the operating microscope. Lack of stereopsis was considered a minor drawback. The VITOM-90 permitted a natural head and neck position. Operating room personnel and residents reported improved visualization of the anatomy. Using the VITOM-90 benefited surgeons during pineal region surgery by reducing strain and allowing the surgeon to operate from a comfortable position without increased operative time or complications. The improved comfort levels may translate into safer, more accurate surgeries in this complex area.