{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T22:47:29Z","timestamp":1768258049782,"version":"3.49.0"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T00:00:00Z","timestamp":1717718400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T00:00:00Z","timestamp":1717718400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum RWTH Aachen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>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\u20132019). 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>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\u00ae <jats:italic>n<\/jats:italic>\u2009=\u20091; AEOS\u00ae <jats:italic>n<\/jats:italic>\u2009=\u20099).<\/jats:p>\n            <jats:p>Total duration of surgery was comparable between devices (microscope: 313\u00a0min. \u00b1 116 vs. exoscope: 279\u00a0min. \u00b1 42;\u00a0<jats:italic>p<\/jats:italic>\u2009=\u20090.647). Ischemia time also proved similar between groups (microscope: 43\u00a0min. \u00b1 19 vs. exoscope: 41\u00a0min. \u00b1 7;\u00a0<jats:italic>p<\/jats:italic>\u2009=\u20090.701). No differences were noted in bypass patency rates. The number of stiches per anastomosis was similar between visualization devices (microscope: 17\u2009\u00b1\u20094 vs. exoscope: 17\u2009\u00b1\u20092;\u00a0<jats:italic>p<\/jats:italic>\u2009=\u20090.887). In contrast, more additional stiches were needed in microscopic anastomoses after leakage testing the bypass (<jats:italic>p<\/jats:italic>\u2009=\u20090.035).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00701-024-06100-3","type":"journal-article","created":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T17:01:54Z","timestamp":1717779714000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["3D exoscopic versus microscopic superficial temporal artery to middle cerebral artery bypass surgery for moyamoya disease \u2013 a comparative series"],"prefix":"10.1007","volume":"166","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3648-6842","authenticated-orcid":false,"given":"Michael","family":"Veldeman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Rossmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ville","family":"Nurminen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justiina","family":"Huhtakangas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roel Hubert Louis","family":"Haeren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Hafez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mika","family":"Niemela","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Lehecka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,6,7]]},"reference":[{"key":"6100_CR1","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1177\/23969873221144089","volume":"8","author":"A Bersano","year":"2023","unstructured":"Bersano A, Khan N, Fuentes B, Acerbi F, Canavero I, Tournier-Lasserve E, Vajcoczy P, Zedde ML, Hussain S, L\u00e9meret S, Kraemer M, Herve D (2023) European Stroke Organisation (ESO) guidelines on Moyamoya Angiopathy endorsed by vascular European Reference Network (VASCERN). 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