SURG-37. Safety and Outcomes of Glioblastoma Resection Using 3D/4K Exoscope: A Comparative Study with Microsurgical Resection

Abstract BACKGROUND In recent years, the introduction of high-definition 3D/4K exoscopes has rapidly expanded their use in neurosurgical procedures. In brain tumor surgeries, numerous advantages have been reported, including the flexibility of the camera body, ergonomic posture for the surgeon, information integration through heads-up surgery, and the ability for the surgeon, assistants, and staff to share the same monitor view, enhancing team-based decision-making and educational value. However, the clinical impact on resection rate, prognosis, and complications remains underexplored. METHODS We retrospectively analyzed 181 patients with newly diagnosed IDH-wildtype glioblastoma who underwent tumor resection at our institution between 2014 and 2024. Of these, 126 patients underwent microscopic resection and 55 underwent exoscope-assisted resection using either the HawkSight (Mitaka Kohki) or ORBEYE (Olympus). In the exoscope group, we employed information-integrated surgery by displaying navigation and monitoring systems side-by-side on the monitor. In selected cases, electromagnetic navigation with continuous recognition and head-mounted displays were utilized. RESULTS Baseline characteristics (age, sex, preoperative KPS, MGMT methylation) were comparable between groups. The gross total resection rate was 82% in the exoscope group and 75% in the microscope group (p = 0.29). Median progression-free survival (PFS) was 8.1 months in both groups (p = 0.59), and median overall survival (OS) was 21.4 months in the exoscope group and 20.7 months in the microscope group (p = 0.65). Operative time was significantly longer in the microscope group. Postoperative neurological complications such as paresis or aphasia were significantly lower in the exoscope group (7.3% vs. 14.3%). CONCLUSION Exoscope-assisted glioblastoma resection achieved comparable resection rates and survival outcomes to traditional microscopic surgery while significantly reducing postoperative neurological complications. Enhanced visualization with high-definition imaging, clearer images of 5-ALA fluorescence, and integration of surgical navigation and monitoring contributed to safer tumor removal under the exoscope system.