The concept of a hybrid operating room: applications in cerebrovascular surgery.
The use of intraoperative digital substraction angiography (iDSA) is a tool in cerebrovascular surgery. According to recent studies, iDSA has been shown to alter surgical treatment in approximately 12% of cases. Moreover, it has been demonstrated that even experienced cerebrovascular surgeons might not accurately predict the need for iDSA. Intraoperative DSA prevents unnecessary surgical manipulations after occlusion of aneurysms and accurately demonstrates occlusion rates. We present our preliminary experience using routine iDSA within the concept of a hybrid operating room for cerebrovascular surgery. A total of 99 patients underwent iDSA in our hybrid operating room. Indications included intraoperative evaluation of occlusion rate of clipped aneurysms and patency of vicinity vessels (n = 82), chemical angioplasty with papaverin (n = 4), and balloon angioplasty (n = 1). In four (5%) patients, a reposition of the clip was needed due to neck remnant and perfusion of the aneurysm sack after clipping. A total of five cases underwent combined microsurgical and endovascular treatment of ruptured aneurysms and arteriovenous malformations (AVMs). The concept of a hybrid operating room has been considered in the planning and design of operation rooms dedicated to cerebrovascular surgery. Hybrid procedures combining endovascular with microsurgical strategies within the same surgical session are feasible and safe. These procedures are associated with cost-benefit advantages.
Institute of Neuroradiology, Aarau, Switzerland. javier.fandino@ksa.ch
Javier
J
Fandino
Philipp
P
Taussky
Serge
S
Marbacher
Carl
C
Muroi
Michael
M
Diepers
Ali-Reza
AR
Fathi
Luca
L
Remonda
D017542:Aneurysm, Ruptured / Q000601:surgery; D015901:Angiography, Digital Subtraction; D017130:Angioplasty / Q000379:methods; D001165:Arteriovenous Malformations / Q000601:surgery; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods*; D009873:Operating Rooms / Q000379:methods; D010208:Papaverine / Q000627:therapeutic use; D013525:Surgical Instruments; D014057:Tomography, X-Ray Computed; D014665:Vasodilator Agents / Q000627:therapeutic use
D014665:Vasodilator Agents; D010208:Papaverine