Kim Chang Hyeun, Lee Sang Weon, Kim Young Ha, Sung Soon Ki, Son Dong Wuk, Song Geun Sung
Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan, Korea.
J Cerebrovasc Endovasc Neurosurg. 2020 Dec;22(4):258-266. doi: 10.7461/jcen.2020.E2020.10.001. Epub 2020 Dec 18.
To report on combined surgical and/or endovascular procedures for cerebrovascular disease in a hybrid operating room (OR).
Between October 2016 and June 2020, 1832 neurosurgical procedures were performed in a hybrid OR. Our institution's hybrid OR consists of a multi-axis robotic C-arm monoplane digital subtraction angiography (DSA) system with an operating table, 3D-rotational DSA, cone-beam computed tomography (dyna CT), and real-time navigation software. Procedures were categorized into six categories according to purpose (1) simple diagnosis and follow-up, (2) simple endovascular procedure, (3) combination of surgery and endovascular procedures, (4) rescue surgery after endovascular procedures, (5) frameless stereotactic procedure, and (6) other surgeries requiring C-arm.
Of 1832 neurosurgical procedures in the hybrid OR, 1430 were simple diagnosis and follow-up cases, 330 simple endovascular procedures, 8 combination of surgery and endovascular procedures, 15 rescue after endovascular procedure, 40 frameless stereotactic procedures, and 9 other surgeries. Eight cases of combination of surgery and endovascular procedures, safely performed without wasting time on patient transfer, were performed in seven bypass end endovascular procedures and one case of bow-hunter syndrome in complex cerebrovascular disease. After embolization, craniotomy (or craniectomy) and intracerebral hemorrhage removal were performed in eight patients in-situ. Of the 40 frameless stereotactic procedure, 37 were extraventricular drainage before/after coil embolization in subarachnoid hemorrhage patients. They all mounted conduits in their planned locations.
A hybrid OR for combined endovascular and surgical procedures represents a safe and useful strategy for cerebrovascular disease. In hybrid ORs various neurosurgical procedures can be safely and conveniently performed. Hybrid OR will pioneer a new era in neurosurgical procedures.
报告在复合手术室（OR）中针对脑血管疾病进行的联合手术和/或血管内介入手术。
2016年10月至2020年6月期间，在复合手术室进行了1832例神经外科手术。我们机构的复合手术室包括一台带有手术台的多轴机器人C型臂单平面数字减影血管造影（DSA）系统、3D旋转DSA、锥形束计算机断层扫描（动态CT）和实时导航软件。手术根据目的分为六类：（1）简单诊断和随访；（2）单纯血管内介入手术；（3）手术与血管内介入手术联合；（4）血管内介入手术后的补救手术；（5）无框架立体定向手术；（6）其他需要C型臂的手术。
在复合手术室的1832例神经外科手术中，1430例为简单诊断和随访病例，330例为单纯血管内介入手术，8例为手术与血管内介入手术联合，15例为血管内介入手术后的补救手术，40例为无框架立体定向手术，9例为其他手术。8例手术与血管内介入手术联合，在不浪费患者转运时间的情况下安全完成，其中7例为复杂脑血管疾病的搭桥血管内介入手术，1例为弓猎综合征。栓塞后，8例患者在原位进行了开颅（或颅骨切除术）和脑出血清除术。在40例无框架立体定向手术中，37例为蛛网膜下腔出血患者在弹簧圈栓塞前后的脑室外引流。所有操作均在计划位置置入导管。
用于血管内和外科联合手术的复合手术室是治疗脑血管疾病的一种安全有效的策略。在复合手术室中，可以安全、方便地进行各种神经外科手术。复合手术室将开创神经外科手术的新纪元。
