Hybrid surgery refers to a surgical strategy that utilizes a combination of interventional, minimally invasive, radiological, and imaging techniques for treatment. This may involve single-stage or multi-stage procedures. Hybrid surgery for cerebrovascular diseases specifically refers to the combination of microsurgical techniques and interventional treatments. Its primary applications include the treatment of complex intracranial aneurysms, high-grade arteriovenous malformations (AVMs), cerebrovascular and cardiac comorbidities, cerebral arteriovenous fistulas (AVFs), and carotid artery occlusions. Hybrid procedures integrate diagnostic angiography, interventional and/or surgical treatments, and post-treatment angiographic evaluations within a multifunctional operating room, completing all steps in one session.
This approach eliminates the need for patients to be transferred multiple times between the operating room and the radiological suite. Immediate follow-up DSA after the treatment allows for real-time identification and correction of residual issues. This enhances surgical outcomes while reducing patient discomfort and overall treatment burden.
Aneurysm Treatment
Postoperative angiography following aneurysm clipping has shown that 19% of cases require adjustment of the clip due to aneurysm remnants and/or parent vessel occlusion. Similarly, incomplete embolization during endovascular treatment of aneurysms or resultant bleeding often requires a second surgery. Hybrid surgery mitigates such risks and the need for additional procedures.
Preoperative Embolization for Giant AVMs
Preoperative embolization for the surgical resection of giant AVMs, including aneurysms and fistulas, reduces the size of the malformation, minimizes intraoperative bleeding, shortens surgery duration, decreases surgical complexity, and improves patient outcomes. Embolization materials can act as "landmarks," aiding in the identification of deeply located AVMs during surgical dissection and minimizing damage to normal tissues. Post-resection angiography enables the identification of any residual AVMs, which can be addressed immediately, thus avoiding the need for a second surgery.
Emergency Surgery for Hemorrhagic Aneurysms and/or AVMs with Hematoma
In cases of hemorrhagic aneurysms, emergency DSA in the hybrid operating room allows for precise identification of aneurysm location and size. Decisions regarding treatment—whether through interventional embolization, surgical clipping, or a combination of approaches—can then be made, reducing the risk of re-rupture during delays in treatment.
For patients with AVMs accompanied by intracerebral hematoma or brain herniation, intraoperative angiography first determines the location and size of the AVM. Partial embolization may be performed, if needed, followed by craniotomy to evacuate the hematoma and microsurgical resection of the AVM. Immediate postoperative angiography ensures complete resection of the AVM and significantly reduces the time required to stabilize the patient.