Choi Euidon, Lee Jong Young, Jeon Hong Jun, Cho Byung-Moon, Yoon Dae Young
Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Korea.
Department of Radiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Korea.
Br J Neurosurg. 2019 Oct;33(5):490-494. doi: 10.1080/02688697.2019.1617403. Epub 2019 May 16.
To describe our experiences with a fully equipped high-end digital subtraction angiography (DSA) system within a hybrid operating room (OR). A single-plane DSA system with 3-dimensional rotational angiography (3DRA), cone-beam computed tomography, and real-time navigation software was used in our hybrid OR. Between April 2014 and January 2018, 191 sessions of neurovascular procedures were performed in our hybrid OR. After the retrospective review of all cases, the procedures were categorised into five subcategorical procedures according to the dominance of surgical and/or endovascular procedures: intraoperative angiographic evaluation, combined endovascular and surgical procedure, complementary rescue procedure during intervention and surgery, surgical approach for interventional procedure, and frameless stereotaxic operation. Intraoperative angiography revealed unsatisfactory clipping of intracranial aneurysms in 6 (13.6%) patients and remnant AVMs in 1 (16.7%) patient, which were determined as complete surgical outcome via indocyanine green videoangiography. Four cases of blood blister aneurysms and a ruptured posterior inferior cerebellar artery aneurysm were treated using bypass surgery and endovascular trapping. Eight cases of ruptured aneurysm with intracranial haemorrhage (ICH) were treated by partial embolisation and surgical clipping. Two (5.4%) of the 37 cases of pre-mature rupture during clipping were secured by endovascular coil embolisation. In 1 (0.8%) complicated case of 103 intra-arterial (IA) thrombectomy procedures, emergency surgical embolectomy with bypass surgery was performed. Direct puncture of the common carotid artery or vertebral artery was performed to achieve interventional access to treat aneurysm or recanalise vessel occlusions in 7 cases. In 27 cases of ICH, frameless stereotaxic haematoma aspiration was performed using XperGuide® system. All procedures were performed in single sessions without any procedural complications. Hybrid OR with a fully equipped DSA system could provide safe and precise treatment for neurovascular diseases. Hybrid procedures for neurovascular diseases in hybrid OR are a promising new trend.
描述我们在复合手术室中使用全功能高端数字减影血管造影（DSA）系统的经验。我们的复合手术室使用了具备三维旋转血管造影（3DRA）、锥形束计算机断层扫描和实时导航软件的单平面DSA系统。2014年4月至2018年1月期间，我们的复合手术室进行了191例神经血管手术。在对所有病例进行回顾性分析后，根据手术和/或血管内手术的主导程度，将手术分为五类：术中血管造影评估、血管内与手术联合操作、介入与手术期间的辅助抢救操作、介入手术的手术入路以及无框架立体定向手术。术中血管造影显示，6例（13.6%）患者颅内动脉瘤夹闭不充分，1例（16.7%）患者残留动静脉畸形（AVM）；通过吲哚菁绿视频血管造影确定这些患者获得了完全的手术结果。4例血泡样动脉瘤和1例破裂的小脑后下动脉动脉瘤采用搭桥手术和血管内圈套治疗。8例破裂动脉瘤伴颅内出血（ICH）患者采用部分栓塞和手术夹闭治疗。37例夹闭过程中过早破裂的病例中有2例（5.4%）通过血管内弹簧圈栓塞得到妥善处理。在103例动脉内（IA）血栓切除术的1例（0.8%）复杂病例中，进行了急诊外科取栓并联合搭桥手术。7例患者通过直接穿刺颈总动脉或椎动脉实现介入通路，以治疗动脉瘤或使血管闭塞再通。在27例ICH患者中，使用XperGuide®系统进行了无框架立体定向血肿抽吸。所有手术均在单次手术中完成，无任何手术并发症。配备全功能DSA系统的复合手术室可为神经血管疾病提供安全、精确的治疗。复合手术室中神经血管疾病的复合手术是一个有前景的新趋势
