Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Department of Neurointerventional Radiology, University of California, San Francisco, San Francisco, California, USA.
Pediatr Neurosurg. 2022;57(4):245-259. doi: 10.1159/000524875. Epub 2022 May 4.
The benefits of performing open and endovascular procedures in a hybrid neuroangiography surgical suite include confirmation of treatment results and reduction in number of procedures, leading to improved efficiency of care. Combined procedural suites are infrequently used in pediatric facilities due to technical and logistical limitations. We report the safety, utility, and lessons learned from a single-institution experience using a hybrid suite equipped with biplane rotational digital subtraction angiography and pan-surgical capabilities.
We conducted a retrospective review of consecutive cases performed at our institution that utilized the hybrid neuroangiography surgical suite from February 2020 to August 2021. Demographics, surgical metrics, and imaging results were collected from the electronic medical record. Outcomes, interventions, and nuances for optimizing preoperative/intraoperative setup and postoperative care were presented.
Eighteen procedures were performed in 17 patients (mean age 13.4 years, range 6-19). Cases included 14 arteriovenous malformations (AVM; 85.7% ruptured), one dural arteriovenous fistula, one mycotic aneurysm, and one hemangioblastoma. The average operative time was 416 min (range 321-745). There were no intraoperative or postoperative complications. All patients were alive at follow-up (range 0.1-14.7 months). Five patients had anticipated postoperative deficits arising from their hemorrhage, and 12 returned to baseline neurological status. Four illustrative cases demonstrating specific, unique applications of the hybrid angiography suite are presented.
The hybrid neuroangiography surgical suite is a safe option for pediatric cerebrovascular pathologies requiring combined surgical and endovascular intervention. Hybrid cases can be completed within the same anesthesia session and reduce the need for return to the operating room for resection or surveillance angiography. High-quality intraoperative angiography enables diagnostic confirmation under a single procedure, mitigating risk of morbidity and accelerating recovery. Effective multidisciplinary planning enables preoperative angiograms to be completed to inform the operative plan immediately prior to definitive resection.
在杂交神经血管造影手术室内进行开放和血管内手术的好处包括确认治疗效果和减少手术次数，从而提高护理效率。由于技术和后勤限制，联合手术套房在儿科设施中很少使用。我们报告了一家机构使用配备双平面旋转数字减影血管造影和泛手术能力的杂交套房的安全性、实用性和经验教训。
我们对 2020 年 2 月至 2021 年 8 月在我院进行的连续病例进行了回顾性分析，这些病例均使用杂交神经血管造影手术室。从电子病历中收集人口统计学、手术指标和影像学结果。介绍了优化术前/术中设置和术后护理的结果、干预措施和细微差别。
17 例患者中有 18 例（平均年龄 13.4 岁，范围 6-19 岁）进行了手术。病例包括 14 例动静脉畸形（AVM；85.7%破裂）、1 例硬脑膜动静脉瘘、1 例真菌性动脉瘤和 1 例血管母细胞瘤。平均手术时间为 416 分钟（范围 321-745）。无术中或术后并发症。所有患者在随访时均存活（范围 0.1-14.7 个月）。5 例患者出现预期的术后出血性缺陷，12 例患者恢复到基线神经状态。介绍了 4 个具有代表性的病例，展示了杂交血管造影套件的具体、独特应用。
杂交神经血管造影手术室是一种安全的选择，适用于需要联合手术和血管内干预的儿科脑血管病变。杂交病例可以在同一个麻醉疗程内完成，并减少因切除或监测血管造影术而返回手术室的需要。高质量的术中血管造影术可以在单一手术过程中进行诊断确认，降低发病率风险并加速康复。有效的多学科计划使术前血管造影术能够在进行明确切除之前立即完成，以告知手术计划。
