Intraoperative diagnostics of vascular diseases of the brain in a hybrid operating room

   Objective: Studying the results of intraoperative diagnostics in neurovascular pathology by using the capabilities of a hybrid operating room.

   Materials and methods: The hybrid operating room concept encompasses simultaneous haemodynamic control, non-invasive and invasive diagnostics and immediate surgical and/or interventional treatment. Intraoperative diagnostics was performed in a hybrid operating room with the help of flat-detector computed tomography with intravenous contrast enhancement, perfusion, and selective cerebral angiography. For 5 years, 78 diagnostic procedures were performed in the hybrid operating room in 72 patients. 23 patients with cerebral aneurysms underwent intraoperative control using intravenous computed angiography and selective cerebral angiography. Control selective cerebral angiography was performed in 34 patients after combined removal of cerebral arteriovenous malformation. 15 patients with occlusive diseases of the brachiocephalic arteries underwent selective cerebral angiography and computed tomographic perfusion to assess the potential of the anastomosis and the dynamic change in the blood circulation before and after surgery.

   Results: As a result of using the methods of intraoperative diagnostics, 2 cases with incomplete clipping of the aneurysm neck, one case of the residual part of the arteriovenous malformation, and one case of intraoperative arteriovenous malformation rupture at the stage of endovascular embolization were revealed. As a result of intraoperative diagnostics, the effectiveness of extra-intracranial anastomoses was confirmed in 9 cases of occlusive diseases of the internal carotid artery, in 5 cases of Moya-Moya disease, in 8 cases of complex aneurysms.

   Conclusion: The hybrid operating room concept of intraoperative imaging in vascular pathology of the brain improves results and speeds up the diagnostic process during the operation, which gives advantages in the immediate assessment of the quality of the operation performed. The timely identification of possible complications allows you to change the type of operation without transporting the patient to another operating room.

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