Current status of combined surgical and endovascular methods for intracranial neurovascular diseases in a hybrid operating room

Surgical treatment of intracranial neurovascular diseases primarily comprises two approaches, craniotomy and endovascular intervention. However, one simple approach cannot resolve some complex vascular diseases, and combined operation is necessary. Previously, this type of combined operation was difficult due to an inadequate operating suite. Recently, with the construction of modern hybrid operating rooms and the introduction of advanced software, the hybrid operating room can provide conditions to perform combined treatments. Research on and reports of neurovascular disease treatment in a hybrid operating room are popular. This study searched PubMed for the currently available literature, and a review of the relevant publications revealed that intracranial aneurysms, arteriovenous malformations, dural arteriovenous fistulae, pial arteriovenous fistulae and cerebral sinus thrombosis achieve the best treatment in the hybrid operating room. Intraoperative angiography can help to confirm if aneurysms were clipped completely and if lesions were resected completely. Additionally, three-dimensional reconstruction software can provide precise neuronavigation to access these lesions. For aneurysms and high flow arteriovenous lesions, endovascular manipulation involves occlusion or embolization of the parent artery or feeding artery, which makes surgical treatment convenient. Similar to other manipulations, operations in a hybrid operating room also have some drawbacks, such as operative complications and false-positive and false-negative results. However, the combination of surgical and endovascular methods for intracranial neurovascular diseases in a hybrid operating room is a promising new trend.