Hybrid Operative Room for Vascular Neurosurgery: Applications, Limits, and Perspectives

Abstract

Hybrid operating rooms (HORs) combine a conventional state-of-the-art microsurgical theater and advanced imaging technologies, usually an intraoperative digital subtraction angiography (DSA) system. Initially developed for peripheral vascular surgery, HORs are gaining popularity among neurosurgical teams around the world. Based on their recent experience, the authors describe the launch of such a hybrid room in the University Hospital of Dijon Bourgogne and, through a narrative review of the pertinent literature, try to define the specific vascular neurosurgery conditions that may benefit from this highly demanding multidisciplinary environment. The association between intraoperative diagnostic and interventional endovascular capabilities and microsurgical management in the same location provides the possibility of immediate assessment of the surgical results, the immediate conversion to one or other technique if needed without transferring the patient, and appears to provide a very high cure rate of neurovascular malformations while minimizing the morbidity and mortality.

Keywords: Angiography; Arteriovenous malformation; Cerebral aneurysm; Dural arteriovenous fistula; Endovascular surgery; Hybrid operating room; Intraoperative imaging; Microneurosurgery.