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 eve
- PDF / 741,561 Bytes
- 5 Pages / 595.28 x 790.87 pts Page_size
- 85 Downloads / 162 Views
Abstract 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. Keywords Intraoperative angiography • Cerebrovascular surgery • Hybrid operation room
J. Fandino, M.D. (), P. Taussky, M.D., S. Marbacher, M.D., C. Muroi, M.D., M. Diepers, M.D., A.-R. Fathi, M.D., and L. Remonda, M.D. Department of Neurosurgery and Institute of Neuroradiology (MD, LR), Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland e-mail: [email protected]
Introduction Intraoperative digital subtraction angiography (iDSA) is still a rarely applied tool in cerebrovascular surgery. In recent studies, iDSA has been shown to alter surgical treatment in approximately 12% of cases [1–4]. It prevents unnecessary surgical manipulations after occlusion of aneurysms and accurately demonstrates occlusion rates. The introduction of iDSA within a hybrid operation room enables the combinations of endovascular and microsurgical techniques in cerebrovascular surgery. We present our experience and concept of a hybrid operating room for interdisciplinary treatment of cerebral aneurysms and arteriovenous malformations (AVMs).
Materials and Methods The hybrid operating room is defined as a surgical theater that enables the combination of endovascular and surgical treatment of cerebrovascular pathologies and the use of interventional tools such as temporary occlusion during clipping in a single procedure. In our experience, the combination of mono- or biplanar angiography apparatus with standard surgical tables is crucial to allow standard positioning of the patient during surgery. The surgical table (Alphamaquet 1150, Maquet AG, Switzerland) a
Data Loading...
