| BackgroundPatient and market forces continue to push for minimally invasive approaches over more traditional open surgical approaches with proven efficacy and long-term treatment benefit. Recent developments in neurosurgery have led to the installation of hybrid operating rooms (ORs) that allow both surgical and endovascular procedures. In 2012, Shandong university Qilu hospital neurosurgery department started to use this platform for the treatment of complex neurosurgical disease, it is one of the earliest clinical application in neurosurgical field domestically.ObjectiveThe purpose of this study is to report our clinical experience performing hybrid operations on neurosurgical diseases in the hybrid OR. To evaluate the application value of this technique in neurosurgery.Methods22 patients with neurosurgical diseases underwent combined procedures in a single session in the hybrid OR:12 were with intracranial aneurysm(s),3 were with brain arteriovenous malformation (AVM),4 were with vascular stenosis,3 were with meningioma. Analysis from clinical features, surgical procedure, treatment results, complications, follow-up 5 aspects.ResultsFor total 12 cases of intracranial aneurysms,3 cases grade 0(unruptrued aneurysm),8 cases grade Ⅱ,1 case grade Ⅲ in Hunt-Hess grade.19 aneurysms were found in all the patients,13 were operated. The hybrid procedures include 1 case of extracranial-to-intracranial bypass followed by endovascular Guglielmi detachable coil (GDC) packing,2 cases of proximal vessel balloon temporary occlusion (BTO) followed by aneurysm clipping,2 cases of salvage operation after intraoperative rupture during endovascular GDC packing, and 7 cases of super-selective angiography followed by surgical clipping, Intraoperative Digital Subtraction Angiography (iDSA) showed 12 aneurysms (92.3%) were completely eliminated. Time of surgery ranged from 4hrs to 12hrs 30min (mean 6hrs 38min). Hemorrhage during operation ranged from 100ml to 2000ml (mean 575ml).1 patient developed severe electrolyte disorder, pneumonia, hydrocephalus after surgery and transferred to ICU for further medication. All cases followed 6 to 35 months (mean 11.6 months),9 patients (75%) had DSA or CTA re-examination, showed no residual or relapse of aneurysm(s).2 patients with posterior communicating artery (PcomA) aneurysm leave with oculomotor paralysis sequela, a patient with middle cerebral artery (MCA) aneurysm leave mild activity obstacle, a patient who received salvage surgery of intraoperative aneurysm rupture (IOR) is in persistent vegetative state.4 cases grade 0,4 cases grade 1,2 cases grade 2, a case grade 3 and a case grade 5 in modified Rankin scale (mRS).All of 3 cases were ruptured AVM, Spetzler-Martin classification Ⅱ to Ⅲ. The hybrid procedures include AVM resection and aneurysm clipping followed by super-selective angiography, AVM embolization followed by hematoma evacuation, AVM resection clipping followed by super-selective angiography. iDSA confirmed that all the lesions were eliminated. Time of surgery ranged from 5hrs to llhrs 30min (mean 7hrs 30min). Hemorrhage during operation ranged from 200ml to 600ml (mean 400ml). Intracranial infection was found in 1 case, soon controlled by antibiotics. All cases followed 5 to 11 months, mRS ranged from 0 to 2.We operated 6 sites of vascular stenosis on 4 patients. The hybrid procedures include carotid endarterectomy (CEA) followed by vertebral artery stenting, CEA followed by subclavian artery stenting, CEA followed by distal carotid artery stenting, CEA followed by super-selective angiography, technique success rate 100%. Time of surgery ranged from 2hrs 20min to 7hrs 10min (mean 4hrs 26min).1 patient complicated acute heart infarction after surgery and transferred to Dept. of cardiology. All cases followed 3 to 8 months,3 case grade 0,1 case grade 1 in mRS.3 cases are all diagnostic with sphenoid ridge meningioma,3-5cm in diameter, branches of middle meningeal artery and internal carotid artery (ICA) supply. All of the cases received tumor resection after supplying arteries embolization in a single session, one lesion cannot totally removed (G4 resection) because of too much bleeding. Time of surgery ranged from 5hrs 20min to 6hrs 30min (mean 6hrs 6min). Hemorrhage during operation ranged from 200ml to 1500ml (mean 667ml).2 cases (1 case lost to follow) followed 12 months, a patient CT re-examination showed no residual or relapse, a patient with residual received gamma knife therapy 5 months after operation, followed CT showed still a small remain. mRS ranged from 0 to 1.Conclusion1) Hybrid operating technique acheives one stop solution of preoperative diagnosis, intraoperative evaluation, treatment, post-operative evaluation and retreatment (if need). Provides individualized diagnosis and treatment. The combined disciplinary procedures enable innovation in the treatment of more complex diseases, expand the indication spectrum. The integration of multimodalities and information system into clinical practice may lead to more improved accuracy, stability, and safety in comparison with conventional techniques, most patients have good outcomes.2) Compared with the staged procedures, hybrid operation eliminated logistic concerns about the timing or sequencing of separate procedures and minimized the inconvenience of transferring patients and exposure to anesthesia, save time and costs.3) Hybrid operating technique mainly used in such aneurysm, AVM, carotid stenosis etc. vascular diseases and meningioma, hemangiopericytoma etc. vascularity tumors. Besides, have great potential in emergency and severe neurological diseases. |
PDF Full Text Request