Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2020; 8(6): 1056-1064
Published online Mar 26, 2020. doi: 10.12998/wjcc.v8.i6.1056
Application of hybrid operating rooms for treating spinal dural arteriovenous fistula
Nai Zhang, Wen-Qiang Xin
Nai Zhang, Wen-Qiang Xin, Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China
Author contributions: Xin WQ and Zhang N designed the study, acquired the data, drafted the article, analyzed and interpreted the data, and revised the article critically for important intellectual content together; all the authors approved the version to be published.
Supported by the Tianjin Science and Technology Projects in Key Areas of Traditional Chinese Medicine, No. 2018001.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Tianjin Medical University General Hospital.
Informed consent statement: All patients gave informed consent to the study.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this study.
Data sharing statement: The datasets acquired during the current study are available from the corresponding author based on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wen-Qiang Xin, MD, Academic Research, Chief Doctor, Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China. xinwenqiangdr@126.com
Received: November 11, 2019
Peer-review started: November 11, 2019
First decision: January 17, 2020
Revised: February 24, 2020
Accepted: March 11, 2020
Article in press: March 11, 2020
Published online: March 26, 2020
Processing time: 135 Days and 13.6 Hours
Abstract
BACKGROUND

A hybrid operating room (hybrid-OR) is a surgical space that combines a conventional operating room with advanced medical imaging devices.

AIM

To explore and summarize the technical features and effectiveness of the application of a hybrid-OR in dealing with spinal dural arteriovenous fistulas (SDAVFs).

METHODS

Eleven patients with SDAVFs were treated with the use of a hybrid-OR at the Department of Neurosurgery of our hospital between January 2015 and December 2018. The dual-marker localization technique was used in the hybrid-OR to locate the SDAVFs and skin incision, and the interoperative digital subtraction angiography (DSA) technique was used before and after microsurgical ligation of the fistulae in the hybrid-OR to verify the accuracy of obliteration. The patients were followed for an average of 2 years after the operation, and the preoperative American Spinal Cord Injury Association (ASIA) score and postoperative ASIA score at 6 mo after the operation were compared.

RESULTS

The location and skin incision of the SDAVFs were accurately obtained by using the dual-marker localization technique in the hybrid-OR in all patients, and there were no cases that required expansion of the range of the bone window in order to expose the lesions. Intraoperative error obliteration occurred and was identified in two patients by using the intraoperative DSA technique; therefore, the findings provided by the intraoperative DSA system significantly changed the surgical procedure in these two patients. With the assistance of the hybrid-OR, the feeding artery was correctly ligated in all cases, and the intraoperative error obliteration rate decreased from 18.2% (2/11) to 0%. All 11 patients were followed for an average of 2 years. The ASIA score at 6 mo after the operation was significantly improved compared with the preoperative ASIA score, and there were no patients with late recurrence during the follow-up.

CONCLUSION

Compared with intra-arterial embolization for the treatment of SDAVFs, hybrid-ORs can solve the problem of a higher incidence of initial failure and late recurrence. Compared with direct occlusion of SDAVFs in microsurgery, hybrid-ORs can take advantage of the intraoperative DSA system for locating the shunt and verifying the obliteration of fistulae in order to reduce the error obliteration rate. At this point, our experience suggests that the safety and ease of use make hybrid-ORs combined with microsurgery and intraoperative DSA systems an attractive modality for dealing with SDAVFs.

Keywords: Spinal dural arteriovenous fistula; Hybrid operating room; Dual-marker localization technique; Interoperative DSA technique; Retrospective study

Core Tip: We retrospectively analyzed our single-institution 4-year case series study on spinal dural arteriovenous fistulas (SDAVFs) treated in a hybrid operating room (hybrid-OR). We aimed to explore and summarize the technical features and effectiveness of the application of a hybrid-OR in dealing with SDAVFs. Using the dual-marker localization technique in a hybrid-OR is highly effective and time-saving for locating SDAVFs, and the use of the interoperative digital subtraction angiography technique in hybrid-ORs can significantly reduce the error obliteration rates of the microsurgery procedure.