title: Hybrid operating room for the treatment of complex neurovascular and brachiocephalic lesions.
abstract: BACKGROUND
  We examine the impact of the installation of integrated hybrid operating rooms (ORs) that allow both surgical and endovascular procedures and are designed for less invasive and 1-stage treatment of complex neurovascular lesions.
  
  
  METHODS
  We retrospectively analyzed our experience in the treatment of complex neurovascular lesions in a hybrid OR.
  
  
  RESULTS
  Three patients with distal middle cerebral artery (MCA) aneurysms underwent a proximal clip occlusion or endovascular trapping with a superficial temporal artery-MCA bypass after correct localization of the recipient branch distal to the aneurysm using superselective intra-arterial infusion of indocyanine green under an operating microscope. Two patients with innominate artery stenosis were treated with retrograde stenting from the common carotid artery (CCA) with distal protection of the internal carotid artery (ICA) alone, and with antegrade stenting with dual protection of the ipsilateral ICA and the vertebral artery. Two patients with tandem stenosis of the proximal CCA and carotid bifurcation underwent 1-stage retrograde stenting combined with a carotid endarterectomy. A patient with the innominate artery and the proximal CCA stenosis underwent staged percutaneous antegrade angioplasty of the innominate artery followed by retrograde stenting of both lesions. A patient with tandem stenosis of the subclavian and innominate arteries underwent 1-stage retrograde stenting. In 2 patients with carotid stenosis that was difficult to access via the endovascular route, carotid stenting was performed by direct puncture of the proximal CCA. No patients suffered from new postoperative neurologic deficits.
  
  
  CONCLUSIONS
  The integration of a high-end hybrid OR enables combined endovascular and surgical procedures for complex neurovascular and brachiocephalic lesions in a 1-stage treatment.
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: kiihara@hsp.ncvc.go.jp.
authors.forename: Koji
authors.initials: K
authors.lastname: Iihara
authors.forename: Tetsu
authors.initials: T
authors.lastname: Satow
authors.forename: Toshinori
authors.initials: T
authors.lastname: Matsushige
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Kataoka
authors.forename: Norio
authors.initials: N
authors.lastname: Nakajima
authors.forename: Kenji
authors.initials: K
authors.lastname: Fukuda
authors.forename: Makoto
authors.initials: M
authors.lastname: Isozaki
authors.forename: Daisuke
authors.initials: D
authors.lastname: Maruyama
authors.forename: Takuro
authors.initials: T
authors.lastname: Nakae
authors.forename: Nobuo
authors.initials: N
authors.lastname: Hashimoto
mesh_terms: D000328:Adult; D000368:Aged; D016122:Brachiocephalic Trunk / Q000473:pathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000473:pathology / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000401:mortality / Q000601:surgery*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000401:mortality / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods / Q000401:mortality; D009873:Operating Rooms / Q000458:organization & administration*; D059035:Perioperative Period / Q000401:mortality; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods / Q000401:mortality