Combined Endovascular and Surgical Treatment for Brain Arteriovenous Malformations in Biplanar Hybrid Operating Room

Scoring the Clinical Application of a Novel Scale in a Hybrid Operating Room for Neurosurgery

OBJECTIVE

The lack of clarity regarding the application performance of a hybrid operating room (HOR) and the uncertainty of surgical scheduling often lead to its inefficient application. This study aimed to review the clinical application of our neurosurgical HOR and propose a scale to score cases clearly.

METHODS

We reviewed the operating procedures and duration of stay in 1865 HOR cases. The actual procedures of each case were summarized into 5 application types, and numerical assignment was used to distinguish the dependence of each type on our HOR: surgical procedures combined with interventional procedures (4 points, the highest dependence), surgical procedures combined with imaging procedures (3 points), interventional procedures (2 points), imaging procedures (1 point), and surgical procedures (0 points, the lowest dependence).

RESULTS

A novel scale that could score 1865 cases into those 5 grades was developed. The percentages by grade were as follows: 4 points, 4.24%; 3 points, 4.88%; 2 points, 20.75%; 1 point, 69.38%; and 0 points, 0.75%. The cumulative usage time was 4241.9 h, the duration of which was as follows: 4 points, 16.17%; 3 points, 15.50%; 2 points, 31.32%; 1 point, 35.62%; and 0 points, 1.39%.

CONCLUSIONS

The HOR serves as a multifunctional room to treat neurosurgical diseases. The scale helps to quickly prioritize cases that rely more on HOR, providing guidelines for surgical scheduling. Although our HOR is unsuitable for emergency cases, it clearly shows the application performance of our HOR to provide a reference for promoting its efficient application.

Multiple Myeloma Treatment Challenges: A Case Report of Vertebral Artery Pseudoaneurysm Complicating Occipitocervical Arthrodesis and a Review of the Literature

Multiple myeloma is a hematological neoplasm that frequently affects the spinal column. Less than a fifth of this vertebral involvement corresponds to the cervical spine and cranio-cervical junction. When there is instability or neurological involvement due to compression or deformity, approaches for anterior decompression and occipitocervical stabilization are required. The correct managment of vertebral artery aneurysm associated with occipitocervical arthrodesis requires extensive knowledge of anatomy and pathology. We present a case of a vertebral pseudoaneurysm that occurred late after the resection of a C1-C2 vertebral body multiple myeloma lesion managed with endonasal endoscopic approach and posterior occipitocervical arthrodesis as well as a systematic review of the related literature. The patient recovered well, without major neurological deficits.