J Cerebrovasc Endovasc Neurosurg > Volume 22(4); 2020 > Article
Journal of Cerebrovascular and Endovascular Neurosurgery 2020;22(4):258-266.
DOI: https://doi.org/10.7461/jcen.2020.E2020.10.001    Published online December 18, 2020.
The experience of surgery and endovascular procedure of cerebrovascular disease in the hybrid operating room; Multi-axis robotic C-arm DSA system
Chang Hyeun Kim, Sang Weon Lee  , Young Ha Kim, Soon Ki Sung, Dong Wuk Son, Geun Sung Song
Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan, Korea
Correspondence:  Sang Weon Lee, Tel: +82-55-360-2126, Fax: +82-55-360-2156, 
Email: sangweonlee@pusan.ac.kr
Received: 5 October 2020   • Revised: 29 October 2020   • Accepted: 12 November 2020
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.
Key Words: Hybrid operating room, DSA system, Neurosurgical procedure, Endovascular surgery
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Sang Weon Lee

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