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Grüter BE, Croci D, Vakharia K, Gruber P, Taussky P. Editorial: Hybrid (combined endovascular and microsurgical) treatments for cerebrovascular diseases. Front Neurol 2024; 15:1378269. [PMID: 38533415 PMCID: PMC10964722 DOI: 10.3389/fneur.2024.1378269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/19/2024] [Indexed: 03/28/2024] Open
Affiliation(s)
- Basil E. Grüter
- Institute of Neuroradiology, Aarau Cantonal Hospital, Aarau, Switzerland
- Service de Neuroradiologie, Hôpital de la Timone, Marseille, France
| | - Davide Croci
- Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, FL, United States
| | - Kunal Vakharia
- Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, FL, United States
| | - Philipp Gruber
- Institute of Neuroradiology, Aarau Cantonal Hospital, Aarau, Switzerland
| | - Philipp Taussky
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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Gharios M, El-Hajj VG, Frisk H, Ohlsson M, Omar A, Edström E, Elmi-Terander A. The use of hybrid operating rooms in neurosurgery, advantages, disadvantages, and future perspectives: a systematic review. Acta Neurochir (Wien) 2023; 165:2343-2358. [PMID: 37584860 PMCID: PMC10477240 DOI: 10.1007/s00701-023-05756-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/08/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Hybrid operating rooms (hybrid-ORs) combine the functionalities of a conventional surgical theater with the advanced imaging technologies of a radiological suite. Hybrid-ORs are usually equipped with CBCT devices providing both 2D and 3D imaging capability that can be used for both interventional radiology and image guided surgical applications. Across all fields of surgery, the use of hybrid-ORs is gaining in traction, and neurosurgery is no exception. We hence aimed to comprehensively review the use of hybrid-ORs, the associated advantages, and disadvantages specific to the field of neurosurgery. MATERIALS AND METHODS Electronic databases were searched for all studies on hybrid-ORs from inception to May 2022. Findings of matching studies were pooled to strengthen the current body of evidence. RESULTS Seventy-four studies were included in this review. Hybrid-ORs were mainly used in endovascular surgery (n = 41) and spine surgery (n = 33). Navigation systems were the most common additional technology employed along with the CBCT systems in the hybrid-ORs. Reported advantages of hybrid-ORs included immediate assessment of outcomes, reduced surgical revision rate, and the ability to perform combined open and endovascular procedures, among others. Concerns about increased radiation exposure and procedural time were some of the limitations mentioned. CONCLUSION In the field of neurosurgery, the use of hybrid-ORs for different applications is increasing. Hybrid-ORs provide preprocedure, intraprocedure, and end-of-procedure imaging capabilities, thereby increasing surgical precision, and reducing the need for postoperative imaging and correction surgeries. Despite these advantages, radiation exposure to patient and staff is an important concern.
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Affiliation(s)
- Maria Gharios
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Victor Gabriel El-Hajj
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Department of Neurosurgery, Karolinska University Hospital, Eugeniavägen 6, 4Th Floor, Solna, 17164, Stockholm, Sweden.
| | - Henrik Frisk
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Ohlsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Artur Omar
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Choi E, Lee JY, Cho HJ, Yoon DY. Surgical exposure of the vertebral artery for endovascular access in a hybrid operating room. Acta Neurochir (Wien) 2022; 164:1271-1280. [PMID: 35083556 DOI: 10.1007/s00701-022-05136-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/18/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Endovascular procedures are a desirable treatment option for neurovascular lesions in posterior circulation. However, endovascular access occasionally fails due to tortuosity of the proximal vertebral artery (VA), aortic arch, and/or VA ostium stenosis. We aimed to describe the creation of endovascular access via surgical exposure of the VA in a hybrid operating room to overcome anatomical difficulties hampering distal access to the VA through the transfemoral or transradial approach. METHODS We present six patients with seven posterior circulation lesions in whom distal access via the conventional approach to the VA was impossible. Surgical exposure of the VA was performed to provide endovascular access to these patients. Radiographic characteristics, operative techniques, and outcomes were reviewed. RESULTS Surgical exposure of the VA was performed in six patients with cerebral aneurysm (n = 4) and symptomatic stenosis of the VA ostium (n = 3). There were four female and two male patients, aged 73-82 years. Surgical exposure was usually performed beyond the tortuous segments of the VA. After endovascular access was provided, coil embolization was performed for cerebral aneurysms and/or balloon angioplasty and stenting was performed to treat the VA ostium stenosis. All puncture sites were closed by direct suture using a 7-0 Prolene suture. All procedures were completed without adverse events. CONCLUSION Endovascular access via surgical exposure of the VA is a feasible and safe alternative for patients in whom the femoral or radial route does not allow the navigation and stabilization of the guiding catheter into the proximal segment of the VA.
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Kikkawa Y, Kurita H. Management of Wide-Necked Basilar tip Aneurysms. Adv Tech Stand Neurosurg 2022; 44:297-307. [PMID: 35107687 DOI: 10.1007/978-3-030-87649-4_17] [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] [Indexed: 06/14/2023]
Abstract
While the frequency of direct surgery for basilar tip aneurysms is decreasing, the need for safe and effective surgical treatments for difficult-to-treat aneurysms, including large or wide-necked aneurysms, is likely to continue. In this chapter, our surgical approach for large wide-necked basilar tip aneurysms using the orbitozygomatic approach, the anterior temporal approach, and hybrid surgery are described.
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Affiliation(s)
- Yuichiro Kikkawa
- Department of Neurosurgery, Saitama Cardiovascular Respiratory Center, Kumagaya, Japan.
| | - Hiroki Kurita
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
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Harfouche M, Abdou H, Adnan SM, Romagnoli AN, Martinson JR, Madurska MJ, Dubose JJ, Scalea TM, Morrison JJ. Integrating Endovascular and Operative Intervention in Trauma. J Surg Res 2021; 267:82-90. [PMID: 34139394 DOI: 10.1016/j.jss.2021.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 03/15/2021] [Accepted: 04/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patterns of utilization of the hybrid operating room (hybrid-OR) in trauma have not been described. The aim of this study was to describe the sequencing and integration of endovascular and operative interventions in trauma using a hybrid-OR. MATERIALS AND METHODS This is a single-center, retrospective cohort study of trauma patients who underwent both endovascular and operative intervention (2013-2019). Patients were separated into four groups based on procedure patterns: concomitant-linked (C-L), concomitant-independent, serial-linked (S-L) and serial-independent (S-I). The groups were defined as follows: C-L - related endovascular and operative interventions in the same OR; concomitant-independent - unrelated interventions in the same OR; S-L - related interventions in separate ORs; S-I - unrelated interventions in separate ORs. Patient characteristics, procedures performed and time to angiography in each group were analyzed. RESULTS Out of 202 patients, most procedures utilizing the hybrid-OR were for hemorrhage control (84.1%) and were performed in a C-L manner (36.1%). Patients in the C-L group were most likely to undergo lower extremity revascularization and received the most transfusions. Patients in the S-L and S-I groups were more severely injured, had greater severe abdominal injury and were more likely to undergo damage control surgery and solid organ interventions, respectively. The C-L group had the highest percentage of patients to undergo angiography within 12 h (77%, P = 0.053). CONCLUSION The hybrid-OR is an ideal space for hemorrhage control in trauma, but there is room for improvement in the triage of patients with non-compressible torso hemorrhage. Current practice patterns prioritize the hybrid-OR for management of lower extremity injury and are not optimal. Use of the hybrid-OR could be improved by concomitant management of patients with severe abdominal injury requiring damage control surgery.
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Affiliation(s)
- Melike Harfouche
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland
| | - Hossam Abdou
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland
| | - Sakib M Adnan
- Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Anna N Romagnoli
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland
| | - James R Martinson
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland
| | - Marta J Madurska
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland
| | - Joseph J Dubose
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland
| | - Thomas M Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland
| | - Jonathan J Morrison
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland.
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Jin H, Lu L, Liu J, Cui M. A systematic review on the application of the hybrid operating room in surgery: experiences and challenges. Updates Surg 2021; 74:403-415. [PMID: 33709242 DOI: 10.1007/s13304-021-00989-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/28/2021] [Indexed: 11/28/2022]
Abstract
The hybrid operating room has been widely applied in different surgery sub-specialties. We aim to identify the advantages of hybrid operating rooms by focusing on intraoperative imaging and explore what to do for further improving its application. We searched related literature in websites including Pubmed, MEDLINE, Web of science, using the keywords ("hybrid operating room" or "integrated operating room" or "multifunctional operating room") and ("surgery" or "technique" or "intervention" or "radiology"). All the searched papers were screened and underwent quality evaluation. A total of 30 literature was eventually identified after full-text screening. These articles covered 10 countries and presented data for 15,558 individuals. The median sample size was 536 (range 8-12,804). Application of the hybrid operating room in general surgery, neurosurgery, thoracic surgery, urology, gynaecologic and obstetrics surgery, cardiovascular surgery, was summarized. Four different operative indicators were applied (operative duration, mortality rate, operation success rate and complication rate). A hybrid OR could significantly increase the operation success rate and reduce operative duration, mortality rates, and complication rates. Further efforts could be made to reduce radiation exposure in the hybrid operating room and increase its cost-effectiveness ratio.
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Affiliation(s)
- Hao Jin
- The Second Department of General Surgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai City, China
| | - Ligong Lu
- Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), No. 79 of Kangning Road, Xiangzhou District, Zhuhai City, 519000, Guangdong Province, China.
| | - Junwei Liu
- Zhuhai Health Bureau, No. 351 of east Meihua Road, Xiangzhou District, Zhuhai City, 519000, Guangdong Province, China.
| | - Min Cui
- China's Communist Party Committee, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), No. 79 of Kangning Road, Xiangzhou District, Zhuhai City, 519000, Guangdong Province, China.
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Abstract
BACKGROUND AND OBJECTIVE The hybrid operating room has been widely applied in surgery, including neurology, general surgery, gynecology, and obstetrics. By reviewing application of the hybrid operating room in different categories of surgery, we aim to summarize both advantages and disadvantages of the hybrid operating room and discuss what to do for further improving the application of it. METHODS We searched related literature in websites including Pubmed, MEDLINE, Web of science, using the keywords "hybrid operating room", "surgery", "technique", "intervention", and "radiology". All the searched papers were screened and underwent quality evaluation. The eventually selected papers were carefully read, with related information extracted and summarized. RESULTS After screening and assessment, a total of 29 literature was collected. Application of the hybrid operating room in general surgery, neurosurgery, thoracic surgery, urology, gynecologic and obstetrics surgery, and cardiovascular surgery was summarized. Both advantages and disadvantages of the hybrid operating room were discussed in order to improve application of the hybrid operating room in surgery. CONCLUSIONS Surgeries performed in the hybrid operating room take advantages over those conventional operating rooms mainly in terms of higher procedure accuracy, less operative time, and less risk of hemorrhage during the transportation between radiology departments and operating suites. Further efforts should be made to reduce radiation exposure from imaging systems equipped in the hybrid operating room and increase cost-effectiveness ratio of the hybrid operating room.
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Affiliation(s)
- Hao Jin
- The Second Department of General Surgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong, China
| | - Junwei Liu
- Zhuhai Health Bureau, Zhuhai, Guangdong, China
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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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Elkin K, Khan U, Hussain M, Ding Y. Developments in hybrid operating room, neurointensive care unit, and ward composition and organization for stroke management. Brain Circ 2019; 5:84-89. [PMID: 31334361 PMCID: PMC6611190 DOI: 10.4103/bc.bc_11_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 01/19/2023] Open
Abstract
Stroke is the leading cause of adult disability in the US. Rapid diagnosis and treatment of stroke, in addition to efficacious rehabilitation, is invaluable. The present review aims to report the recent improvements in hybrid operating rooms (hybrid ORs), and in the organization of Neurological intensive care unit (NICUs) and dedicated stroke wards (SWs), which contribute to enhanced stroke treatment. A PubMed literature review was conducted in addition to the collection of other online media releases regarding recent organizational advances in stroke care. PubMed keywords included but were not limited to “neurological intensive care unit,” “hybrid operating room,” and “stroke ward,” while all other online information regarding recent advances in the physical organization was selected and synthesized in accord with its relevance. The current research indicates that hybrid ORs facilitate surgical innovation and improved patient care through the colocation of advanced imaging modalities and surgical capabilities. Moreover, the recent reorganization of NICUs and SWs may lead to better-quality initial treatment and rehabilitation. The present review also considers the current ER triage protocol for stroke patients, and it concludes with relevant considerations relating to the role of the physical hospital structure and organization in stroke care.
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Affiliation(s)
- Kenneth Elkin
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Usama Khan
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Mohammed Hussain
- Department of Neurology, University of Connecticut, Farmington, CT, USA
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Research and Development Center, John D. Dingell VA Medical Center, Detroit, Michigan, USA
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