Four-Year Experience Using an Advanced Interdisciplinary Hybrid Operating Room : Potentials in Treatment of Cerebrovascular Disease

Abstract

ObjectiveTo describe our experiences with a fully equipped high-end digital subtraction angiography (DSA) system within a hybrid operating room (OR).MethodsA single-plane DSA system with 3-dimensional rotational angiography, cone-beam computed tomography (CBCT), and real-time navigation software was used in our hybrid OR. Between April 2014 and January 2018, 191 sessions of cerebrovascular procedures were performed in our hybrid OR. After the retrospective review of all cases, the procedures were categorized into three subcategorical procedures : combined endovascular and surgical procedure, complementary rescue procedure during intervention and surgery, and frameless stereotaxic operation.ResultsForty-nine of 191 procedures were performed using hybrid techniques. Four cases of blood blister aneurysms and a ruptured posterior inferior cerebellar artery aneurysm were treated using bypass surgery and endovascular trapping. Eight cases of ruptured aneurysm with intracranial hemorrhage (ICH) were treated by partial embolization and surgical clipping. Six cases of ruptured arteriovenous malformation with ICH were treated by Onyx embolization of nidus and subsequent surgical removal of nidus and ICH. Two (5.4%) of the 37 cases of pre-mature rupture during clipping were secured by endovascular coil embolization. In one (0.8%) complicated case of 103 intra-arterial thrombectomy procedures, emergency surgical embolectomy with bypass surgery was performed. In 27 cases of ICH, frameless stereotaxic hematoma aspiration was performed using XperGuide® system (Philips Medical Systems, Best, the Netherlands). All procedures were performed in single sessions without any procedural complications.ConclusionHybrid OR with a fully equipped DSA system could provide precise and safe treatment strategies for cerebrovascular diseases. Especially, we could suggest a strategy to cope flexibly in complex lesions or unexpected situations in hybrid OR. CBCT with real-time navigation software could augment the usefulness of hybrid OR.

Trans-lamina terminalis approach assisted by endovascular temporary basilar artery occlusion for high-positioned, recurrent, basilar tip aneurysm: A technical case report

“…As this case demonstrates, the recent development of the hybrid OR has provided new strategies for neurosurgeons to approach complex basilar tip aneurysms. [4,5,9,[12][13][14]…”

Developments in hybrid operating room, neurointensive care unit, and ward composition and organization for stroke management

“…For stroke patients, the use of mechanical thrombectomy and other surgical cerebrovascular treatments is a current area of innovation. [181920] Hybrid ORs can also be used for penetrating head trauma and other hybrid neurosurgical procedures including hemorrhagic stroke.…”

“…Although hybrid ORs have become integral in the majority of hospitals, one challenge is the initial cost which is estimated to be between 2 and 4 million dollars. [20] This cost must be recuperated, and to do this, the OR must be in constant use, so “reserving it for emergencies becomes difficult.” However, many studies indicate that the hybrid OR allows for reduced hospital costs and other positive cost-benefit outcomes. [1021] Additional barriers include having the availability of simultaneous technological and nursing personnel to cycle between the OR and imaging setting.…”

Surgical treatment of cerebrovascular diseases in a hybrid operating room

“…Однако в тех случаях, когда отсутствует эндоваскулярный доступ и невозможно МХ-удаление, единственным вариантом лечения ДФ становится гибридное вмешательство. Различные авторы отмечают преимущество гибридной операционной, когда выполненный МХ-доступ к ДФ позволяет одномоментно выключить фистулу эндоваскулярно [12,15,21,22]. Вопрос планирования объема и вида оперативного вмешательства в гибридной операционной в зависимости от степени сложности нейроваскулярной патологии недостаточно освещен в научной литературе.…”

“…Целесообразно использовать возможности гибридной операционной при развитии таких интраоперационных осложнений, как разрыв церебральных анев-ризм (ЦА), артериовенозных мальформаций (АВМ), когда необходимо быстро сменить метод хирургии, а задержки по времени могут значительно ухудшить исходы лечения. Авторы описывают эффективность и благоприятные исходы при быстрой смене вида хирургического вмешательства в гибридной операционной при интраоперационных разрывах ЦА и АВМ головного мозга [7,11,14,15].…”