Zhang Nai, Xin Wen-Qiang
Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China.
World J Clin Cases. 2020 Mar 26;8(6):1056-1064. doi: 10.12998/wjcc.v8.i6.1056.
A hybrid operating room (hybrid-OR) is a surgical space that combines a conventional operating room with advanced medical imaging devices.
To explore and summarize the technical features and effectiveness of the application of a hybrid-OR in dealing with spinal dural arteriovenous fistulas (SDAVFs).
Eleven patients with SDAVFs were treated with the use of a hybrid-OR at the Department of Neurosurgery of our hospital between January 2015 and December 2018. The dual-marker localization technique was used in the hybrid-OR to locate the SDAVFs and skin incision, and the interoperative digital subtraction angiography (DSA) technique was used before and after microsurgical ligation of the fistulae in the hybrid-OR to verify the accuracy of obliteration. The patients were followed for an average of 2 years after the operation, and the preoperative American Spinal Cord Injury Association (ASIA) score and postoperative ASIA score at 6 mo after the operation were compared.
The location and skin incision of the SDAVFs were accurately obtained by using the dual-marker localization technique in the hybrid-OR in all patients, and there were no cases that required expansion of the range of the bone window in order to expose the lesions. Intraoperative error obliteration occurred and was identified in two patients by using the intraoperative DSA technique; therefore, the findings provided by the intraoperative DSA system significantly changed the surgical procedure in these two patients. With the assistance of the hybrid-OR, the feeding artery was correctly ligated in all cases, and the intraoperative error obliteration rate decreased from 18.2% (2/11) to 0%. All 11 patients were followed for an average of 2 years. The ASIA score at 6 mo after the operation was significantly improved compared with the preoperative ASIA score, and there were no patients with late recurrence during the follow-up.
Compared with intra-arterial embolization for the treatment of SDAVFs, hybrid-ORs can solve the problem of a higher incidence of initial failure and late recurrence. Compared with direct occlusion of SDAVFs in microsurgery, hybrid-ORs can take advantage of the intraoperative DSA system for locating the shunt and verifying the obliteration of fistulae in order to reduce the error obliteration rate. At this point, our experience suggests that the safety and ease of use make hybrid-ORs combined with microsurgery and intraoperative DSA systems an attractive modality for dealing with SDAVFs.
杂交手术室（hybrid-OR）是一种将传统手术室与先进医学成像设备相结合的手术空间。
探讨并总结杂交手术室在处理硬脊膜动静脉瘘（SDAVF）中的技术特点及应用效果。
2015年1月至2018年12月，我院神经外科采用杂交手术室对11例SDAVF患者进行治疗。在杂交手术室中采用双标记定位技术定位SDAVF及皮肤切口，在杂交手术室中对瘘口进行显微结扎前后采用术中数字减影血管造影（DSA）技术验证闭塞的准确性。术后平均随访2年，比较术前美国脊髓损伤协会（ASIA）评分及术后6个月的ASIA评分。
所有患者在杂交手术室中采用双标记定位技术均准确获得了SDAVF的位置及皮肤切口，无一例需要扩大骨窗范围以暴露病变。2例患者术中出现闭塞误差，通过术中DSA技术得以发现；因此，术中DSA系统提供的结果显著改变了这2例患者的手术方式。在杂交手术室的辅助下，所有病例均正确结扎了供血动脉，术中闭塞误差率从18.2%（2/11）降至0%。11例患者均平均随访2年。术后6个月的ASIA评分较术前显著改善，随访期间无患者出现晚期复发。
与动脉内栓塞治疗SDAVF相比，杂交手术室可解决初次失败和晚期复发发生率较高的问题。与显微手术直接闭塞SDAVF相比，杂交手术室可利用术中DSA系统定位分流并验证瘘口闭塞情况，以降低闭塞误差率。就此而言，我们的经验表明，安全性和易用性使杂交手术室联合显微手术及术中DSA系统成为处理SDAVF的一种有吸引力的方式。
