title: Hybrid Operating Room for Combined Neuroendovascular and Endoscopic Treatment of Ruptured Cerebral Aneurysms with Intraventricular Hemorrhage.
abstract: BACKGROUND
  Intraventricular hemorrhages (IVHs) caused by ruptured cerebral aneurysms often have poor outcomes. Treatment challenges include comorbidities, increased intracranial pressure caused by IVH, and risk of rebleeding.
  
  
  METHODS
  Two cases of severe IVH accompanied by acute hydrocephalus caused by ruptured aneurysm were treated with coil embolization followed by endoscopic hematoma evacuation as a single treatment session in a hybrid operating room (OR) equipped with a multipurpose angio biplane system. The first case was an 84-year-old woman with a ruptured basilar top aneurysm, who presented with Hunt and Hess (H&H) grade 5 subarachnoid hemorrhage (SAH) with packed IVH. The second case was a 43-year-old man with a ruptured anterior communicating artery aneurysm who presented with H&H grade 5 SAH with packed IVH. In both cases, endovascular coil embolization was performed first to prevent intraoperative bleeding. The coiled aneurysms suddenly appeared on the screen of the endoscope during the hematoma removal, which could have led to massive rebleeding if not treated previously. Neither patient needed a reinsertion of the ventricular drainage or developed chronic hydrocephalus during hospitalization. The hybrid OR enabled the 2 treatment approaches to be performed without the need to transfer the patient, thereby minimizing the transition time between the modalities. Intraoperative cone-beam computed tomography contributed to the evaluation of residual clots.
  
  
  CONCLUSIONS
  A hybrid OR may contribute to a combined neuroendoscopic and endovascular treatment for ruptured cerebral aneurysms with severe intraventricular hemorrhage.
authors.affiliation: Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan. Electronic address: ryotam@jikei.ac.jp.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Mori
authors.affiliation: Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yuki
authors.affiliation: Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Ikki
authors.initials: I
authors.lastname: Kajiwara
authors.affiliation: Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Nonaka
authors.affiliation: Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Ishibashi
authors.affiliation: Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Kostadin
authors.initials: K
authors.lastname: Karagiozov
authors.affiliation: Siemens Healthcare K.K., Tokyo, Japan.
authors.forename: Chiheb
authors.initials: C
authors.lastname: Dahmani
authors.affiliation: Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Murayama
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D044583:Neuroendoscopy / Q000379:methods*; D009873:Operating Rooms / Q000379:methods*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D015898:Tomography Scanners, X-Ray Computed
keywords: Coil embolization; Hybrid operating room; Intraventricular hemorrhage; Neuroendoscopy; Subarachnoid hemorrhage