Surgical treatment of cerebrovascular diseases in a hybrid operating room

Abstract

Background. Surgical treatment of complex neurovascular pathology remains an important problem requiring use of a combination of various techniques. Utilization of a hybrid operating room allows to simultaneously or sequentially combine microsurgical and endovascular surgical methods which can improve treatment outcomes.Aim. To improve surgical treatment of patients with cerebrovascular pathology by utilizing the capabilities of a hybrid operating room.Materials and methods. Surgical interventions were performed in a hybrid operating room with a combination of endovascular and microsurgical methods for treating the following cerebrovascular pathologies: complex dural fistulas, complex aneurysms, arteriovenous malformations. The type of surgical intervention – hybrid, combined, staged – was chosen in accordance with the nature of the pathology.Results. In 5 years, 41 patients underwent surgery in the hybrid operating room. Among them, 33 patients had arteriovenous malformations, 6 had complex aneurysms, 2 had complex dural fistulas. Combination interventions were performed in 27 patients, staged – in 12, hybrid – in 2. According to the Modified Rankin Scale (mRS) the following outcomes were observed: no complications in cases of complex aneurysms (6 patients) – mRS 0 (points), as well as in cases of dural fistulas (2 patients) – mRS 0 (points); in arteriovenous malformation, 30 patients did not have any complications – mRS 0; 3 patients had complications (of different types) – mRS 1.Conclusions. The combination of microsurgical and endovascular methods of treatment in a hybrid operating room allows to combine the positive features of the two methods in accordance with surgical needs which improves the outcomes of neurosurgical interventions in complex neurovascular pathology.