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Leal AG, Martinazzo EO, Pedro MKF, de Souza MA, Nohama P. Investigation of the Use of Hollow Elastic Biomodels Produced by Additive Manufacturing for Clip Choice and Surgical Simulation in Microsurgery for Intracranial Aneurysms. World Neurosurg 2023; 171:e291-e300. [PMID: 36503118 DOI: 10.1016/j.wneu.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intracranial aneurysms (IAs) are dilatations of the cerebral arteries, whose treatment is commonly based on the implant of a metallic clip on the aneurysm neck. Despite the dissection and understanding of the surgical anatomy of the IA when often only parts of it are visible, the choice of the ideal clip to be used is one of the surgical difficulties. Although current imaging tests guarantee IA visualization, currently there is no planning method that allows for a real three-dimensional (3D) visualization for optimal choice of clip prior to surgery. The aim of this study is to evaluate whether IA biomodels generated by additive manufacturing methods are useful for surgical clip selection in microsurgeries for IA. METHODS Three-dimensional (3D) IA biomodels of 10 patients with IA were evaluated using computerized tomography, surgical microscope, and 3D printer. The research was divided into 4 phases as follows: development of the 3D biomodels, evaluation of the biomodel dimensional characteristics, surgical planning evaluation with the biomodel and its clipping effectiveness, and evaluation of the actual surgical simulation process within the models. RESULTS Ten 3D biomodels were obtained, made of a malleable and hollow part, formed by the IA and related arteries, and another rigid part, mimicking the skull and other arteries of the skull base. Based on these 3D models, 10 clips were chosen during the surgical planning, and all exactly matched the clip characteristics used during the actual surgeries. The surgical simulation with the biomodels performed by 2 neurosurgeons still in training obtained 100% accuracy in the identification of the clips that were eventually used during the actual surgeries. CONCLUSIONS 3D biomodels generated by additive manufacturing methods were effective for surgical clip selection in microsurgeries for IA, reducing surgical time, increasing cerebral angioarchitecture understanding, and providing more safety in this type of surgery.
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Affiliation(s)
- André Giacomelli Leal
- Neurovascular Department, Neurological Institute of Curitiba, Curitiba, Parana, Brazil.
| | - Enzo Oku Martinazzo
- Medical Student, Pontifical Catholic University of Parana, Curitiba, Parana, Brazil
| | | | - Mauren Abreu de Souza
- Post-Graduation Program in Health Technology, Pontifical Catholic University of Parana, Curitiba, Parana, Brazil
| | - Percy Nohama
- Post-Graduation Program in Health Technology, Pontifical Catholic University of Parana, Curitiba, Parana, Brazil
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Sharma V, Garg M, Bhaskar S, Tiwari S, Bhatia PK, Jha DK. Handmade models for aneurysm surgery: A useful tool for training. Surg Neurol Int 2022; 13:571. [PMID: 36600742 PMCID: PMC9805621 DOI: 10.25259/sni_941_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/26/2022] [Indexed: 12/14/2022] Open
Abstract
Background Aneurysm surgery is considered difficult by young and trainee neurosurgeons. This is due to difficulty in understanding orientation of aneurysm complex (proximal and distal vessels, aneurysm neck, and fundus) in relation to the surrounding structures (skull, brain, vessels, and nerves) after head is rotated, extended, and fixed on the head frame. Virtual three-dimensional (3D) imaging studies and 3D-printed models help young neurosurgeons but are not accessible to most of the centers due to need for resources (human and equipment). Authors used handmade 3D models of aneurysm complex to train young neurosurgeons before and during surgery to make them understand steps to treat it. Methods RadiAnt DICOM viewer software (2022.1.1, 64-bit, Medixant, Poznan, Poland) was used for acquiring 3D Volume Rendering Technique images to make aneurysm models preoperatively. Twisted 20 Gauze galvanized iron wires were used for making proximal and distal branches and Epoxy Putty (M-seal, Pidilite ® industries, Mumbai, India) was used to make smooth surfaces of the vessels, aneurysm necks, and fundi. Models were used in operating room (OR) before and during surgery to help surgeons and trainees get oriented to the aneurysm complexes. Results Handmade models, oriented as per patients' head position, were useful to make surgeons and trainees to understand projection of various components of the aneurysm complex in relation to adjacent structures, especially skull base, during both preoperative planning and in OR even before completion of the dissection. Conclusion Handmade models of aneurysms are inexpensive tool and can help trainee neurosurgeons to plan and execute surgical management of aneurysms.
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Affiliation(s)
- Vikrant Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mayank Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Suryanarayanan Bhaskar
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pradeep Kumar Bhatia
- Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepak Kumar Jha
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India,Corresponding author: Deepak Kumar Jha, Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
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Calbucci F, Draghi R, Borghesi I. Commentary: Combined Endovascular and Microsurgical Management of a Tentorial Arteriovenous Malformation in a Hybrid Neurovascular Operating Room: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E459-E460. [PMID: 34432057 DOI: 10.1093/ons/opab296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fabio Calbucci
- Department of Neurosurgery, Maria Cecilia Hospital, GVM Care&Research, Cotignola, Italy
| | - Riccardo Draghi
- Department of Neurosurgery, Maria Cecilia Hospital, GVM Care&Research, Cotignola, Italy
| | - Ignazio Borghesi
- Department of Neurosurgery, Maria Cecilia Hospital, GVM Care&Research, Cotignola, Italy
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Goren O, Bourdages G, Schirmer CM, Weiner G, Dalal SS, Griessenauer CJ. Intraoperative 3-Dimensional Rotational Angiography in Cerebrovascular Surgery: A Case Series. World Neurosurg 2020; 141:e736-e742. [PMID: 32535054 DOI: 10.1016/j.wneu.2020.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Intraoperative imaging is critical in cerebrovascular surgery to assess the technical success of the operation. This case series aimed to evaluate the safety and efficacy of 3-dimensional rotational angiogram (3D-RA) in addition to 2-dimensional intraoperative angiography (2D-IOA) during cerebrovascular surgery in the hybrid operating room. METHODS All consecutive patients who underwent open cerebrovascular surgery and intraoperative 2D-IOA with 3D-RA in a hybrid operating room at 2 academic centers between August 2018 and December 2019 were identified from a prospectively maintained institutional database. Medical charts and operative videos including intraoperative angiography were reviewed, and clinical and angiographic outcomes assessed. RESULTS A total of 40 cerebrovascular surgeries in 39 patients (mean age, 53 ± 13 years; 51% female) were carried out with the addition of 3D-RA to 2D-IOA in the hybrid operating room. After 3D-RA in addition to 2D-IOA, 1 (2.5%) surgical alteration occurred in an aneurysm clipping. Other procedures were not altered with the addition of 3D-RA to 2D-IOA. There were no complications from the addition of 3D-RA to 2D-IOA. CONCLUSIONS Using a combination of 3D-RA and 2D-IOA in the hybrid operating room may enhance the likelihood of achieving an optimal result when employing microsurgical cerebrovascular surgery and avoid unanticipated incomplete outcomes, complications, and returns to the operating room. Whereas the addition of 3D-RA elucidated residual aneurysm not otherwise visualized on the 2D-IOA, in other cerebrovascular procedures studied, there was no additional value of the 3D-RA over the 2D-IOA.
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Affiliation(s)
- Oded Goren
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA.
| | - George Bourdages
- Geisinger Commonwealth School of Medicine, Danville, Pennsylvania, USA
| | - Clemens M Schirmer
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA; Department of Neurosurgery, Geisinger, Wyoming-Valley, Pennsylvania, USA; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Gregory Weiner
- Department of Neurosurgery, Geisinger, Wyoming-Valley, Pennsylvania, USA
| | - Shamsher S Dalal
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA; Department of Radiology, Geisinger, Danville, Pennsylvania, USA
| | - Christoph J Griessenauer
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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Three-dimensional visualization of aneurysm wall calcification by cerebral angiography: Technical case report. J Clin Neurosci 2020; 73:290-293. [PMID: 32067827 DOI: 10.1016/j.jocn.2020.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/09/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND We describe on a 57-year-old man with an incidental middle cerebral artery (MCA) aneurysm in whom a preoperative standard three-dimensional rotational angiogram (3D-RA) was used to depict luminal morphology along with 3D density rendering to precisely locate aneurysm wall calcification. METHODS To detect aneurysm calcification, a native 3D rotational angiogram was acquired for calcium density visualization, followed by an intraarterial contrast-enhanced 3D rotational angiogram in the same location. Both data sets were postprocessed obtaining a 3D calcium volume rendering on a 3D-RA. RESULTS Depiction of both the MCA luminal aneurysm morphology as well as calcium-rich components in the aneurysm wall was valuable to determine treatment strategy towards surgery. CONCLUSION Imaging of luminal morphology and calcification within the same angiographic procedure allows for a plain and simple estimation of the degree and distribution of brain aneurysm wall calcification with limited amount of additional radiation dosage.
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Tabata S, Kamide T, Ikeda T, Kikkawa Y, Kasakura S, Kohyama S, Kurita H. Trans-lamina terminalis approach assisted by endovascular temporary basilar artery occlusion for high-positioned, recurrent, basilar tip aneurysm: A technical case report. Surg Neurol Int 2020; 11:13. [PMID: 32038885 PMCID: PMC7006445 DOI: 10.25259/sni_493_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/07/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Coil embolization is increasingly becoming the surgical intervention of choice for cerebral aneurysms, particularly for those in the posterior circulation. However, in cases where it is difficult to perform coil embolization, microsurgical clipping is still required. Case Description: We present a case of a high-positioned, ruptured, recurrent basilar tip aneurysm treated with a combination of microsurgical clipping through the trans-lamina terminalis approach and endovascular procedure. The technical considerations of this approach are discussed. Conclusion: Microsurgical clipping through the trans-lamina terminalis approach combined with an endovascular technique can be effective for basilar tip aneurysms. This approach is particularly useful for high-positioned, small, anterior projective aneurysms and cases with dilation of the third ventricle due to hydrocephalus or clot.
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Affiliation(s)
- Shinya Tabata
- Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University
| | - Tomoya Kamide
- Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University
| | - Toshiki Ikeda
- Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University
| | - Yuichiro Kikkawa
- Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University
| | - Shigen Kasakura
- Department of Neuroendovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
| | - Shinya Kohyama
- Department of Neuroendovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama
| | - Hiroki Kurita
- Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University
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Van Der Veken J, Mulcahy MJ, Harrington TJ, Assaad NN. Kinked Perforator Due to Clipping of Parent Vessel Aneurysm: Technical Note and Lessons Learned. World Neurosurg 2019; 128:473-476. [PMID: 31132497 DOI: 10.1016/j.wneu.2019.05.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/17/2019] [Accepted: 05/18/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adverse outcomes after aneurysm clipping can be potentially reversible, when managed appropriately. METHODS This is a case report describing kinking of a perforator due to clipping of parent vessel aneurysm. RESULTS Complete recovery of a high-grade motor deficit was achieved after instant reintervention with application of smaller clips in combination with gelfoam soaked in papaverine. CONCLUSION Use of evoked potentials and intraoperative digital subtraction angiography are recommended and may help in preclinical diagnosis. Knowledge of delayed perforator kinking as a complication may lead to a more rapid diagnosis and management.
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Affiliation(s)
- Jorn Van Der Veken
- Department of Neurosurgery, Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia.
| | - Michael J Mulcahy
- Department of Neurosurgery, Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Timothy J Harrington
- Department of Neurosurgery, Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia; Department of Radiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Nazih N Assaad
- Department of Neurosurgery, Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia
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Choi E, Lee JY, Jeon HJ, Cho BM, Yoon DY. A hybrid operating room for combined surgical and endovascular procedures for cerebrovascular diseases: a clinical experience at a single centre. Br J Neurosurg 2019; 33:490-494. [PMID: 31092005 DOI: 10.1080/02688697.2019.1617403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose: To describe our experiences with a fully equipped high-end digital subtraction angiography (DSA) system within a hybrid operating room (OR). Material and methods: 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. Results: 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. Conclusion: 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.
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Affiliation(s)
- Euidon Choi
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Korea
| | - Jong Young Lee
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Korea
| | - Hong Jun Jeon
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Korea
| | - Byung-Moon Cho
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Korea
| | - Dae Young Yoon
- Department of Radiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Korea
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The State of the Hybrid Operating Room: Technological Acceleration at the Pinnacle of Collaboration. CURRENT SURGERY REPORTS 2019. [DOI: 10.1007/s40137-019-0229-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Kan I, Kato N, Otani K, Abe Y, Ishibashi T, Murayama Y. Intravenous 3-Dimensional Digital Subtraction Angiography During Surgical Treatment of Intracranial Aneurysm. World Neurosurg 2019; 126:533-536. [PMID: 30862577 DOI: 10.1016/j.wneu.2019.02.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although intraarterial 3-dimensional digital subtraction angiography (ia-3DDSA) using an angiographic C-arm system is still the gold standard for postoperative confirmation of surgical clipping of intracranial aneurysms, ia-3DDSA requires catheterization and intraarterial injection of contrast medium, which adds risks to the surgical procedure and takes time. We propose a less invasive acquisition of 3D digital subtraction angiography with intravenous injection (iv-3DDSA) in the hybrid operating room to confirm the results of surgical clipping immediately after surgery. CASE DESCRIPTION A 56-year-old woman was diagnosed with an incidental wide-necked aneurysm located at the distal anterior cerebral artery. We performed surgical clipping. During the surgery, indocyanine green video angiography and Doppler ultrasonography were used for confirmation, and after the surgery iv-3DDSA and ia-3DDSA were performed with the angiography C-arm system in the hybrid operating room while the patient was still under anesthesia. We could confirm that there was no neck remnant left and that the parent vessels were patent on both iv-3DDSA and ia-3DDSA images. The image quality of iv-3DDSA was sufficient for all treatment evaluations and offered the additional benefits of visualizing the whole angioarchitecture including the contralateral side, being less invasive, and requiring only a few minutes until the availability of images. CONCLUSIONS Iv-3DDSA can be useful for postsurgical confirmation of clipping of aneurysms in the hybrid operating room.
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Affiliation(s)
- Issei Kan
- Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan.
| | - Naoki Kato
- Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan
| | - Katharina Otani
- Siemens Healthcare K.K., AT Innovation Department, Tokyo, Japan
| | - Yukiko Abe
- Department of Radiology, The Jikei University Hospital, Tokyo, Japan
| | | | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan
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Liao CH, Chen WH, Lee CH, Shen SC, Tsuei YS. Treating cerebrovascular diseases in hybrid operating room equipped with a robotic angiographic fluoroscopy system: level of necessity and 5-year experiences. Acta Neurochir (Wien) 2019; 161:611-619. [PMID: 30610374 DOI: 10.1007/s00701-018-3769-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 12/11/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND A hybrid operating room (OR) equipped with robotic angiographic fluoroscopy system has become prevalent in neurosurgery. The level of necessity of the hybrid OR in treating cerebrovascular diseases (CVD) is rarely discussed. OBJECTIVE The authors proposed a scoring and classification system to evaluate the cerebrovascular procedures according to the level of treatment necessity for CVD in a hybrid OR and shared our 5-year experiences. METHODS From December 2009 to January 2016, the registry of cerebrovascular procedures performed in the hybrid OR was retrieved. A scoring system was used to evaluate the importance of the surgical and interventional components of a cerebrovascular procedure performed in the hybrid OR. The score of either component ranged from 1, 1.5, to 2 (1 = no role, 1.5 = supplementary or informative, 2 = important or therapeutic). The total score of a procedure was by multiplying two individual scores. Levels of necessity were classified into level A (important), level B (beneficial), and level C (replaceable). RESULTS A total of 1027 cerebrovascular procedures were performed during this period: diagnostic angiography in 328, carotid artery stenting in 286, aneurysm coiling in 128, intra-operative DSA in 101, aspiration of ICH under image guidance in 79, intra-arterial thrombolysis/thrombectomy in 51, intracranial angioplasty/stenting in 30, hybrid surgery/serial procedures in 19, and rescue surgery during embolization in 5. According to the scoring system, hybrid surgery and serial procedures scored the highest points (2 × 2). The percentages distributed at each level: levels A (2.3%), B (17.5%), and C (80.2%). CONCLUSION This study conveys a concept of what a hybrid OR equipped with robotic angiographic fluoroscopy system is capable of and its potential. For cerebrovascular diseases, hybrid OR exerts its value via hybrid surgery or avoiding patient transportation in serial procedures (level A), via providing real-time high-quality angiography and image guidance (level B), which constituted about 20% of the cases. The subspecialty of the group using the hybrid OR directly reflects on the number of procedures categorized in each level. In a hybrid OR, innovative treatment strategies for difficult-to-treat CVD can be developed.
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Affiliation(s)
- Chih-Hsiang Liao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Wen-Hsien Chen
- Department of Neuroradiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Hsin Lee
- Department of Neurosurgery, Taichung Tzu Chi Hospital, Taichung, Taiwan
| | - Shih-Chieh Shen
- Department of Neurosurgery, Tri-service General Hospital Songshan Branch, Taipei, Taiwan
| | - Yuang-Seng Tsuei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
- Department of Neurosurgery, National Defense Medical Center, Tri-service General Hospital, Taipei, Taiwan.
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Jeon HJ, Lee JY, Cho BM, Yoon DY, Oh SM. Four-Year Experience Using an Advanced Interdisciplinary Hybrid Operating Room : Potentials in Treatment of Cerebrovascular Disease. J Korean Neurosurg Soc 2018; 62:35-45. [PMID: 30630294 PMCID: PMC6328792 DOI: 10.3340/jkns.2018.0203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/13/2018] [Indexed: 12/22/2022] Open
Abstract
Objective To describe our experiences with a fully equipped high-end digital subtraction angiography (DSA) system within a hybrid operating room (OR). Methods A single-plane DSA system with 3-dimensional rotational angiography, cone-beam computed tomography (CBCT), and real-time navigation software was used in our hybrid OR. Between April 2014 and January 2018, 191 sessions of cerebrovascular procedures were performed in our hybrid OR. After the retrospective review of all cases, the procedures were categorized into three subcategorical procedures : combined endovascular and surgical procedure, complementary rescue procedure during intervention and surgery, and frameless stereotaxic operation. Results Forty-nine of 191 procedures were performed using hybrid techniques. 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 hemorrhage (ICH) were treated by partial embolization and surgical clipping. Six cases of ruptured arteriovenous malformation with ICH were treated by Onyx embolization of nidus and subsequent surgical removal of nidus and ICH. Two (5.4%) of the 37 cases of pre-mature rupture during clipping were secured by endovascular coil embolization. In one (0.8%) complicated case of 103 intra-arterial thrombectomy procedures, emergency surgical embolectomy with bypass surgery was performed. In 27 cases of ICH, frameless stereotaxic hematoma aspiration was performed using XperGuide® system (Philips Medical Systems, Best, the Netherlands). All procedures were performed in single sessions without any procedural complications. Conclusion Hybrid OR with a fully equipped DSA system could provide precise and safe treatment strategies for cerebrovascular diseases. Especially, we could suggest a strategy to cope flexibly in complex lesions or unexpected situations in hybrid OR. CBCT with real-time navigation software could augment the usefulness of hybrid OR.
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Affiliation(s)
- Hong Jun Jeon
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jong Young Lee
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Byung-Moon Cho
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dae Young Yoon
- Department of Radiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sae-Moon Oh
- Health Insurance Review and Assessment Service, Seoul, Korea
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Goertz L, Kabbasch C, Borggrefe J, Hamisch C, Telentschak S, von Spreckelsen N, Stavrinou P, Timmer M, Brinker G, Goldbrunner R, Krischek B. Preoperative Three-Dimensional Angiography May Reduce Ischemic Complications During Clipping of Ruptured Intracranial Aneurysms. World Neurosurg 2018; 120:e1163-e1170. [DOI: 10.1016/j.wneu.2018.09.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/02/2018] [Accepted: 09/04/2018] [Indexed: 12/12/2022]
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Leal A, Souza M, Nohama P. Additive Manufacturing of 3D Biomodels as Adjuvant in Intracranial Aneurysm Clipping. Artif Organs 2018; 43:E9-E15. [DOI: 10.1111/aor.13303] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/21/2018] [Accepted: 05/31/2018] [Indexed: 11/29/2022]
Affiliation(s)
- André Leal
- Neurovascular Department; Neurological Institute of Curitiba; Curitiba Paraná Brazil
| | - Mauren Souza
- Post-Graduation Program in Health Technology; Pontifícia Universidade Católica do Paraná; Curitiba Paraná Brazil
| | - Percy Nohama
- Post-Graduation Program in Health Technology; Pontifícia Universidade Católica do Paraná; Curitiba Paraná Brazil
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