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academies
Nov12-13, 2018 | Paris, France
Central Nervous System & Therapeutics
International Conference on
Journal of Neurology and Neurorehabilitation Research | Volume 3
Five years of Hybrid Operating Theatre for the treatment of complex Neurovascular lesions at a major
Sydney Hospital
Charles Fish
Royal Prince Alfred Hospital, Australia
Background:
This study demonstrates the utility of a hybrid
angiogram theatre in the management of complex operative
cerebrovascular cases.
Methods:
27 patients over 5 years underwent combined
surgical and endovascular procedures in a single theatre
session. 13 patients underwent emergency surgery for acute
vascular events and 14 patients underwent scheduled elective
cases. Of the emergency cases, 3 had ruptured intracranial
aneurysms, 3 ruptured AVMs, one a ruptured dural AV fistula,
and 6 ECIC bypasses for complex neurological pathologies.
The elective cases included 2 AVMs, 2 carotid cutdowns
for endovascular treatment of intracranial aneurysm, 9
craniotomies for aneurysm and one EC-IC bypass for aneurysm
bypass and trapping. The average age for AVM treatment was
40 years (range 18-60) and 63 (46-79) for aneurysm clipping.
Of 11 patients with aneurysms treated operatively, 7 required
sub-temporal craniotomies for clipping of large basilar tip
aneurysms not amenable for endovascular treatment.
Results:
Angiogram post AVM resection demonstrated no
residual nidus in all cases. Angiogram post aneurysm clipping
(n=11) demonstrated complete obliteration of the aneurysm
at time of closure, with no recurrences on delayed imaging
out to five years for the earliest cases. 4 of the aneurysm cases
underwent multiple on table angiograms with clip adjustment
subsequent to these to ensure occlusion of the aneurysm sac
and filling of the PCA and SCA vessels despite what was initially
felt to be appropriate clip position.
Conclusion:
We feel that these cases in particular demonstrate
the utility and cost effectiveness of the hybrid theatre in
preventing stroke, returns to theatre and post-operative patient
morbidity and mortality. The disadvantages of the hybrid
theatre include prolonged setup time, longer procedure time
with subsequent possibility of infection and venous thrombosis,
and a decreased case load.
Speaker Biography
Charles Fish completed a Bachelor of Science in Tasmania, followed by MBBS in
Wollongong, Australia. He is currently a third year Neurosurgical Registrar at Royal
Prince Alfred, Australia.
e:
charlestfish@gmail.com