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The introduction of operative microscopes (OMs) is the most important revolution in modern microneurosurgery, as a result of the implementation of lighting and magnification of the surgical field and of the capability to dissect the microneurovascular structures. Recently, the advent of video telescopic intraoperative microscopes or exoscopes (EX) has enlarged these perspectives in neurosurgery.

To systematically review all the pertinent literature.

We systematically reviewed the pertinent literature and collected all the reported experience with EX use in neurosurgery. Quantitative and qualitative data, along with the authors' opinions and concerns, were recorded and analyzed. A comparison with the OM was also considered.

Twenty-nine studies reporting surgical procedures on 574 patients were included in the study. Data analysis was categorized in 3 groups, representing …