{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T01:50:31Z","timestamp":1781488231137,"version":"3.54.1"},"reference-count":70,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,7,6]],"date-time":"2023-07-06T00:00:00Z","timestamp":1688601600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: The exoscope is a high-definition telescope recently introduced in neurosurgery. In the past few years, several reports have described the advantages and disadvantages of such technology. No studies have compared results of surgery with standard microscope and exoscope in patients with glioblastoma multiforme (GBM). Methods: Our retrospective study encompassed 177 patients operated on for GBM (WHO 2021) between February 2017 and August 2022. A total of 144 patients were operated on with a microscope only and the others with a 3D4K exoscope only. All clinical and radiological data were collected. Progression-free survival (PFS) and overall survival (OS) have been estimated in the two groups and compared by the Cox model adjusting for potential confounders (e.g., sex, age, Karnofsky performance status, gross total resection, MGMT methylated promoter, and operator\u2019s experience). Results: IDH was mutated in 9 (5.2%) patients and MGMT was methylated in 76 (44.4%). Overall, 122 patients received a gross total resection, 14 patients received a subtotal resection, and 41 patients received a partial resection. During follow-up, 139 (73.5%) patients experienced tumor recurrence and 18.7% of them received a second surgery. After truncation to 12 months, the median PFS for patients operated on with the microscope was 8.82 months, while for patients operated on with the exoscope it was &gt;12 months. Instead, the OS was comparable in the two groups. The multivariable Cox model showed that the use of microscope compared to the exoscope was associated with lower progression-free survival (hazard ratio = 3.55, 95%CI = 1.66\u20137.56, p = 0.001). Conclusions: The exoscope has proven efficacy in terms of surgical resection, which was not different to that of the microscope. Furthermore, patients operated on with the exoscope had a longer PFS. A comparable OS was observed between microscope and exoscope, but further prospective studies with longer follow-up are needed.<\/jats:p>","DOI":"10.3390\/brainsci13071035","type":"journal-article","created":{"date-parts":[[2023,7,7]],"date-time":"2023-07-07T01:41:36Z","timestamp":1688694096000},"page":"1035","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Exoscopic Microsurgery: A Change of Paradigm in Brain Tumor Surgery? Comparison with Standard Operative Microscope"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6148-1894","authenticated-orcid":false,"given":"Andrea","family":"Di Cristofori","sequence":"first","affiliation":[{"name":"Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy"},{"name":"Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1825-3527","authenticated-orcid":false,"given":"Francesca","family":"Graziano","sequence":"additional","affiliation":[{"name":"Bicocca Bioinformatics, Biostatistics and Bioimaging Centre\u2014B4, School of Medicine and Surgery, University of Milano-Bicocca, Piazza Ateneo Nuovo, 120126 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9475-7703","authenticated-orcid":false,"given":"Chiara Benedetta","family":"Rui","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy"},{"name":"Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Rebora","sequence":"additional","affiliation":[{"name":"Bicocca Bioinformatics, Biostatistics and Bioimaging Centre\u2014B4, School of Medicine and Surgery, University of Milano-Bicocca, Piazza Ateneo Nuovo, 120126 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Di Caro","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy"},{"name":"Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaia","family":"Chiarello","sequence":"additional","affiliation":[{"name":"Pathology, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Stefanoni","sequence":"additional","affiliation":[{"name":"Neurology, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Julita","sequence":"additional","affiliation":[{"name":"Radiotherapy, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santa","family":"Florio","sequence":"additional","affiliation":[{"name":"Neuroradiology, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9296-0268","authenticated-orcid":false,"given":"Davide","family":"Ferlito","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy"},{"name":"Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6245-9402","authenticated-orcid":false,"given":"Gianpaolo","family":"Basso","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy"},{"name":"Neuroradiology, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5374-3161","authenticated-orcid":false,"given":"Giuseppe","family":"Citerio","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy"},{"name":"Neurointensive Care Unit, Department of Neuroscience, Fondazione IRCCS San Gerardo deiTintori, Via G.B. Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Remida","sequence":"additional","affiliation":[{"name":"Neuroradiology, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0170-0653","authenticated-orcid":false,"given":"Giorgio","family":"Carrabba","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy"},{"name":"Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9033-2927","authenticated-orcid":false,"given":"Carlo","family":"Giussani","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Piazza Ateneo Nuovo, 120126 Milan, Italy"},{"name":"Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori Via G.B. Pergolesi 33, 20900 Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/j.wneu.2017.06.159","article-title":"The Changing Face of Technologically Integrated Neurosurgery: Today\u2019s High-Tech Operating Room","volume":"106","author":"Bernardo","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_2","first-page":"258","article-title":"Robotics in neurosurgery: A literature review","volume":"68","author":"Ahmed","year":"2018","journal-title":"J. Pak. Med. Assoc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1093\/neuros\/nyx384","article-title":"Natural and Artificial Intelligence in Neurosurgery: A Systematic Review","volume":"83","author":"Senders","year":"2018","journal-title":"Neurosurgery"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"E4","DOI":"10.3171\/2009.6.FOCUS09120","article-title":"Operating microscopes: Past, present, and future","volume":"27","author":"Kujoth","year":"2009","journal-title":"Neurosurg. Focus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"381","DOI":"10.3322\/caac.21693","article-title":"Brain and other central nervous system tumor statistics, 2021. CA","volume":"71","author":"Miller","year":"2021","journal-title":"Cancer J. Clin."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"iii1","DOI":"10.1093\/neuonc\/noab200","article-title":"CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2014\u20132018","volume":"23","author":"Ostrom","year":"2021","journal-title":"Neuro. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.nec.2020.08.002","article-title":"Role of Resection in Glioblastoma Management","volume":"32","author":"Youngblood","year":"2021","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/S1470-2045(09)70025-7","article-title":"Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial","volume":"10","author":"Stupp","year":"2009","journal-title":"Lancet. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1056\/NEJMoa043330","article-title":"Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma","volume":"352","author":"Stupp","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.neuchi.2016.09.006","article-title":"Supratotal resection of diffuse gliomas\u2014An overview of its multifaceted implications","volume":"63","author":"Yordanova","year":"2017","journal-title":"Neurochirurgie"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e101","DOI":"10.1016\/j.wneu.2014.02.015","article-title":"Is supratotal resection of glioblastoma in noneloquent areas possible?","volume":"82","author":"Duffau","year":"2014","journal-title":"World Neurosurg."},{"key":"ref_12","first-page":"625","article-title":"Supramarginal resection of glioblastoma: 5-ALA fluorescence, combined intraoperative strategies and correlation with survival","volume":"63","author":"Certo","year":"2019","journal-title":"J. Neurosurg. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1001\/jamaoncol.2019.6143","article-title":"Association of Maximal Extent of Resection of Contrast-Enhanced and Non-Contrast-Enhanced Tumor With Survival Within Molecular Subgroups of Patients With Newly Diagnosed Glioblastoma","volume":"6","author":"Molinaro","year":"2020","journal-title":"JAMA Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s11060-016-2110-4","article-title":"Maximizing safe resection of low- and high-grade glioma","volume":"130","author":"Berger","year":"2016","journal-title":"J. Neurooncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3171\/2011.2.JNS10998","article-title":"An extent of resection threshold for newly diagnosed glioblastomas","volume":"115","author":"Sanai","year":"2011","journal-title":"J. Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1007\/s11060-022-04232-z","article-title":"Perilesional resection technique of glioblastoma: Intraoperative ultrasound and histological findings of the resection borders in a single center experience","volume":"161","author":"Giussani","year":"2023","journal-title":"J. Neurooncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"639822","DOI":"10.3389\/fneur.2021.639822","article-title":"Perspectives on (A)symmetry of Arcuate Fasciculus. A Short Review About Anatomy, Tractography and TMS for Arcuate Fasciculus Reconstruction in Planning Surgery for Gliomas in Language Areas","volume":"12","author":"Basso","year":"2021","journal-title":"Front. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.wneu.2018.12.202","article-title":"The Exoscope in Neurosurgery: An Innovative \u201cPoint of View\u201d. A Systematic Review of the Technical, Surgical, and Educational Aspects","volume":"124","author":"Ricciardi","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_19","first-page":"e15878","article-title":"The Role of 3D Exoscope Systems in Neurosurgery: An Optical Innovation","volume":"13","author":"Fiani","year":"2021","journal-title":"Cureus"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1007\/s11060-020-03543-3","article-title":"Postoperative outcomes following glioblastoma resection using a robot-assisted digital surgical exoscope: A case series","volume":"148","author":"Baron","year":"2020","journal-title":"J. Neurooncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1150981","DOI":"10.3389\/fsurg.2023.1150981","article-title":"Exoscope and operative microscope for training in microneurosurgery: A laboratory investigation on a model of cranial approach","volume":"10","author":"Calloni","year":"2023","journal-title":"Front. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E10","DOI":"10.3171\/FOC.2008.25.12.E10","article-title":"Comparison of endoscopic and microscopic removal of pituitary adenomas: Single-surgeon experience and the learning curve","volume":"25","author":"Grady","year":"2008","journal-title":"Neurosurg. Focus"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1080\/000155599750009942","article-title":"The dermatoscopic ABCD rule does not improve diagnostic accuracy of malignant melanoma","volume":"79","author":"Lorentzen","year":"1999","journal-title":"Acta Derm. Venereol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1093\/neuonc\/noab106","article-title":"The 2021 WHO classification of tumors of the central nervous system: A summary","volume":"23","author":"Louis","year":"2021","journal-title":"Neuro. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Montemurro, N., Scerrati, A., Ricciardi, L., and Trevisi, G. (2021). The Exoscope in Neurosurgery: An Overview of the Current Literature of Intraoperative Use in Brain and Spine Surgery. J. Clin. Med., 11.","DOI":"10.3390\/jcm11010223"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.wneu.2022.11.043","article-title":"A Comparative Analysis with Exoscope and Optical Microscope for Intraoperative Visualization and Surgical Workflow in 5-Aminolevulinic Acid-Guided Resection of High-Grade Gliomas","volume":"170","author":"Mattogno","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e231","DOI":"10.1016\/j.wneu.2021.10.165","article-title":"The Utility of High-Definition 2-Dimensional Stereotactic Exoscope in Cranial and Spinal Procedures","volume":"158","author":"Abunimer","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"791427","DOI":"10.3389\/fsurg.2021.791427","article-title":"Evaluation of 3D Robotic-Guided Exoscopic Visualization in Microneurosurgery","volume":"8","author":"Keric","year":"2021","journal-title":"Front. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e498","DOI":"10.1016\/j.wneu.2021.01.147","article-title":"A Prospective Validation Study of the First 3D Digital Exoscope for Visualization of 5-ALA-Induced Fluorescence in High-Grade Gliomas","volume":"149","author":"Vogelbaum","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.jocn.2011.07.014","article-title":"Infratentorial supracerebellar resection of a pineal tumor using a high definition video exoscope (VITOM\u00ae)","volume":"19","author":"Mamelak","year":"2012","journal-title":"J. Clin. Neurosci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/j.jocn.2013.10.026","article-title":"Clinical experience with a high definition exoscope system for surgery of pineal region lesions","volume":"21","author":"Birch","year":"2014","journal-title":"J. Clin. Neurosci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"V14","DOI":"10.3171\/2021.4.FOCVID2127","article-title":"V Resection of a pineal region papillary tumor using robotic exoscope: Improved visualization and ergonomics for deep seeded tumor","volume":"5","author":"Huff","year":"2021","journal-title":"Neurosurg. Focus Video"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e571","DOI":"10.1016\/j.wneu.2023.02.094","article-title":"A Multicenter Study Investigating the Surgeon Experience with a Robotic-Assisted Exoscope as Part of the Neurosurgical Armamentarium","volume":"173","author":"Schupper","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"5370","DOI":"10.3390\/curroncol29080426","article-title":"Combined Exoscopic and Endoscopic Two-Step Keyhole Approach for Intracranial Meningiomas","volume":"29","author":"Watanabe","year":"2022","journal-title":"Curr. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1227\/ONS.0000000000000060","article-title":"Visualization and Maneuverability Features of a Robotic Arm Three-Dimensional Exoscope and Operating Microscope for Clipping an Unruptured Intracranial Aneurysm: Video Comparison and Technical Evaluation","volume":"22","author":"Haeren","year":"2022","journal-title":"Oper. Neurosurg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"878293","DOI":"10.3389\/fsurg.2022.878293","article-title":"Exoscope as a Teaching Tool: A Narrative Review of the Literature","volume":"9","author":"Calloni","year":"2022","journal-title":"Front. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e33492","DOI":"10.1097\/MD.0000000000033492","article-title":"Radical resection of trigeminal schwannoma at the cerebellopontine angle with support of the digital robotic exoscope Synaptive Modus V system: A case report and literature review","volume":"102","author":"Chu","year":"2023","journal-title":"Medicine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"V5","DOI":"10.3171\/2021.10.FOCVID21174","article-title":"Contemporary intraoperative visualization for GBM with use of exoscope, 5-ALA fluorescence-guided surgery and tractography","volume":"6","author":"Schupper","year":"2022","journal-title":"Neurosurg. Focus Video"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1007\/s00381-022-05612-6","article-title":"5-ALA fluorescence-guided resection of pediatric low-grade glioma using the ORBEYE 3D digital exoscope: A technical report","volume":"39","author":"Maeda","year":"2023","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_40","first-page":"e2108","article-title":"First Clinical Applications of a High-Definition Three-Dimensional Exoscope in Pediatric Neurosurgery","volume":"10","author":"Beez","year":"2018","journal-title":"Cureus"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"682","DOI":"10.23736\/S0390-5616.18.04466-1","article-title":"Minimally invasive tubular retractor-assisted biopsy and resection of subcortical intra-axial gliomas and other neoplasms","volume":"62","author":"Gassie","year":"2018","journal-title":"J. Neurosurg. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e1268","DOI":"10.1016\/j.wneu.2022.09.008","article-title":"The Characteristic of Light Sources and Fluorescence in the 3-Dimensional Digital Exoscope \u201cORBEYE\u201d for 5-Aminolevulinic Acid-Induced Fluorescence-Guided Surgery Compared with a Conventional Microscope","volume":"167","author":"Ikeda","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.clineuro.2018.09.010","article-title":"Pros and cons of using ORBEYETM for microneurosurgery","volume":"174","author":"Takahashi","year":"2018","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1093\/ons\/opy320","article-title":"First-in-Man Clinical Experience Using a High-Definition 3-Dimensional Exoscope System for Microneurosurgery","volume":"16","author":"Khalessi","year":"2019","journal-title":"Oper. Neurosurg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1055\/s-0040-1719106","article-title":"A Single-Center Experience with the Olympus ORBEYE 4K-3D Exoscope for Microsurgery of Complex Cranial Cases: Technical Nuances and Learning Curve","volume":"82","author":"Muscas","year":"2021","journal-title":"J. Neurol. Surg. A Cent. Eur. Neurosurg."},{"key":"ref_46","first-page":"567","article-title":"Cortical localization of temporal lobe language sites in patients with gliomas","volume":"34","author":"Haglund","year":"1994","journal-title":"Neurosurgery"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"925729","DOI":"10.1155\/2015\/925729","article-title":"From Grey Scale B-Mode to Elastosonography: Multimodal Ultrasound Imaging in Meningioma Surgery-Pictorial Essay and Literature Review","volume":"2015","author":"Prada","year":"2015","journal-title":"Biomed Res. Int."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.wneu.2020.12.168","article-title":"5-ALA Enhanced Fluorescence-Guided Microscopic to Endoscopic Resection of Deep Frontal Subcortical Glioblastoma Multiforme","volume":"148","author":"Strickland","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/S0090-3019(00)00183-X","article-title":"Intraoperative direct subcortical stimulation for identification of the internal capsule, combined with an image-guided stereotactic system during surgery for basal ganglia lesions","volume":"53","author":"Duffau","year":"2000","journal-title":"Surg. Neurol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1227\/01.NEU.0000249206.58601.DE","article-title":"Intraoperative subcortical language tract mapping guides surgical removal of gliomas involving speech areas","volume":"60","author":"Bello","year":"2007","journal-title":"Neurosurgery"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1227\/01.neu.0000243290.36910.a2","article-title":"Intraoperative language localization in multilingual patients with gliomas","volume":"59","author":"Bello","year":"2006","journal-title":"Neurosurgery"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1586\/erd.12.42","article-title":"Neuronavigation in the surgical management of brain tumors: Current and future trends","volume":"9","author":"Orringer","year":"2012","journal-title":"Expert Rev. Med. Devices"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1055\/s-2004-830179","article-title":"Advanced neuronavigation in skull base tumors and vascular lesions","volume":"48","author":"Rohde","year":"2005","journal-title":"Minim. Invasive Neurosurg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"3317","DOI":"10.1007\/s00701-022-05252-4","article-title":"Frameless neuronavigation-assisted brain biopsy with electromagnetic tracking: How I do it?","volume":"164","author":"Veiceschi","year":"2022","journal-title":"Acta Neurochir."},{"key":"ref_55","first-page":"481","article-title":"Intraoperative Functional Monitoring in Brain Tumor Surgery","volume":"51","author":"Motomura","year":"2023","journal-title":"No Shinkei Geka."},{"key":"ref_56","first-page":"775","article-title":"Intraoperative neurosurgical ultrasonography","volume":"62","author":"Shao","year":"1999","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"ref_57","first-page":"174","article-title":"Preoperative magnetic resonance and intraoperative ultrasound fusion imaging for real-time neuronavigation in brain tumor surgery","volume":"36","author":"Prada","year":"2015","journal-title":"Ultraschall Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.ultrasmedbio.2005.01.016","article-title":"Intraoperative sonography of intra- and extramedullary tumors","volume":"31","author":"Regelsberger","year":"2005","journal-title":"Ultrasound Med. Biol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1093\/ons\/opy323","article-title":"Intraoperative Strain Elastosonography in Brain Tumor Surgery","volume":"17","author":"Prada","year":"2019","journal-title":"Oper. Neurosurg."},{"key":"ref_60","first-page":"329","article-title":"Intraoperative MRI in neurosurgery: Technical overkill or the future of brain surgery?","volume":"51","author":"Seifert","year":"2003","journal-title":"Neurol. India"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.nec.2009.04.008","article-title":"Intraoperative MRI with 1.5 Tesla in neurosurgery","volume":"20","author":"Nabavi","year":"2009","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Di Cristofori, A., Carone, G., Rocca, A., Rui, C.B., Trezza, A., Carrabba, G., and Giussani, C. (2023). Fluorescence and Intraoperative Ultrasound as Surgical Adjuncts for Brain Metastases Resection: What Do We Know? A Systematic Review of the Literature. Cancers, 15.","DOI":"10.3390\/cancers15072047"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s11912-018-0723-9","article-title":"How Intraoperative Tools and Techniques Have Changed the Approach to Brain Tumor Surgery","volume":"20","author":"Fatemi","year":"2018","journal-title":"Curr. Oncol. Rep."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1007\/s11060-022-04231-0","article-title":"Optimization of novel exoscopic blue light filter during fluorescence-guided resection of Glioblastoma","volume":"161","author":"Witten","year":"2023","journal-title":"J. Neurooncol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1093\/ons\/opy277","article-title":"Preliminary Clinical Microneurosurgical Experience With the 4K3-Dimensional Microvideoscope (ORBEYE) System for Microneurological Surgery: Observation Study","volume":"16","author":"Murai","year":"2019","journal-title":"Oper. Neurosurg."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"E82","DOI":"10.1093\/ons\/opz139","article-title":"High-Definition 3-Dimensional Exoscope for 5-ALA Glioma Surgery: 3-Dimensional Operative Video","volume":"18","author":"Doglietto","year":"2020","journal-title":"Oper. Neurosurg."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1007\/s00701-013-1976-6","article-title":"Fluorescence-guided surgery in high grade gliomas using an exoscope system","volume":"156","author":"Belloch","year":"2014","journal-title":"Acta Neurochir."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1055\/s-0040-1719108","article-title":"Bur Hole-Based Resections of Intrinsic Brain Tumors with Exoscopic Visualization","volume":"82","author":"Chaichana","year":"2021","journal-title":"J. Neurol. Surg. A Cent. Eur. Neurosurg."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"207974","DOI":"10.1155\/2014\/207974","article-title":"Fluorescence-guided surgery and biopsy in gliomas with an exoscope system","volume":"2014","author":"Piquer","year":"2014","journal-title":"Biomed Res. Int."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"2949","DOI":"10.1007\/s00701-020-04361-2","article-title":"Monitor-based exoscopic 3D4k neurosurgical interventions: A two-phase prospective-randomized clinical evaluation of a novel hybrid device","volume":"162","author":"Roethe","year":"2020","journal-title":"Acta Neurochir."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/7\/1035\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:07:29Z","timestamp":1760126849000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/7\/1035"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,6]]},"references-count":70,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["brainsci13071035"],"URL":"https:\/\/doi.org\/10.3390\/brainsci13071035","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,6]]}}}