Published online Mar 26, 2020. doi: 10.12998/wjcc.v8.i6.1056
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
A hybrid-OR is a surgical space that combines a conventional operating room with advanced medical imaging devices.
Currently, there is no standard of care of established evidence on the application of hybrid operating rooms in the treatment of spinal dural arteriovenous fistulas.
The purpose of this study was to explore and summarize the technical features and effectiveness of the application of hybrid-ORs in dealing with spinal dural arteriovenous fistulas (SDAVFs).
We treated 11 patients with SDAVFs between January 2015 and December 2018 with the use of hybrid-ORs. The dual-marker localization technique was used in the hybrid-OR to locate the SDAVFs and skin incision, and the interoperative DSA technique was used before and after microsurgical ligation of the fistulae in the hybrid-OR to verify the obliteration accuracy.
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 cases 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 ligatured correctly 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.
The hybrid-OR provides new ideas for the surgical treatment of SDVAFs, which effectively and greatly improves the cure rate. The safety and ease of use make hybrid-ORs an attractive modality for dealing with SDAVFs.
Although the hybrid-OR has received widespread attention for the treatment of SDVAFs, there are still no clear conclusions. This study shows that the safety and ease of use make hybrid-ORs combined with microsurgery and intraoperative DSA systems an attractive modality for dealing with SDAVFs.