Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Roadmapping technique in the hybrid operating room for the microsurgical treatment of complex intracranial aneurysms

  • Juan Luis Gomez-Amador (Department of Neurosurgery, National Institute of Neurology and Neurosurgery) ;
  • Cristopher G Valencia-Ramos (Department of Neurosurgery, National Institute of Neurology and Neurosurgery) ;
  • Marcos Vinicius Sangrador-Deitos (Department of Neurosurgery, National Institute of Neurology and Neurosurgery) ;
  • Aldo Eguiluz-Melendez (Department of Neurosurgery, National Institute of Neurology and Neurosurgery) ;
  • Gerardo Y Guinto-Nishimura (Department of Neurosurgery, National Institute of Neurology and Neurosurgery) ;
  • Alan Hernandez-Hernandez (Department of Neurosurgery, National Institute of Neurology and Neurosurgery) ;
  • Samuel Romano-Feinholz (Department of Neurosurgery, National Institute of Neurology and Neurosurgery) ;
  • Luis Alberto Ortega-Porcayo (Department of Neurosurgery, National Institute of Neurology and Neurosurgery) ;
  • Sebastian Velasco-Torres (Department of Neurosurgery, National Institute of Neurology and Neurosurgery) ;
  • Jose J Martinez-Manrique (Department of Neurosurgery, National Institute of Neurology and Neurosurgery) ;
  • Juan Jose Ramirez-Andrade (Department of Neurologcial Endovascular Therapy, National Institute of Neurology and Neurosurgery) ;
  • Marco Zenteno-Castellanos (Department of Neurologcial Endovascular Therapy, National Institute of Neurology and Neurosurgery)
  • Received : 2022.08.14
  • Accepted : 2022.12.19
  • Published : 2023.03.31
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Abstract

Objective: To describe the roadmapping technique and our three-year experience in the management of intracranial aneurysms in the hybrid operating room. Methods: We analyzed all patients who underwent surgical clipping for cerebral aneurysms with the roadmapping technique from January 2017 to September 2019. We report demographic, clinical, and morphological variables, as well as clinical and radiological outcomes. We further describe three illustrative cases of the technique. Results: A total of 13 patients were included, 9 of which (69.2%) presented with subarachnoid hemorrhage, with a total of 23 treated aneurysms. All patients were female, with a mean age of 47.7 years (range 31-63). All cases were anterior circulation aneurysms, the most frequent location being the ophthalmic segment of the internal carotid artery (ICA) in 11 cases (48%), followed by posterior communicating in 8 (36%), and ICA bifurcation in 2 (8%). Intraoperative clip repositioning was required in 9 aneurysms (36%) as a result of the roadmapping technique in the hybrid operating room. There were no residual aneurysms in our series, nor reported mortality. Conclusions: The roadmapping technique in the hybrid operating room offers a complementary tool for the adequate occlusion of complex intracranial aneurysms, as it provides a real time fluoroscopic-guided clipping technique, and clip repositioning is possible in a single surgical stage, whenever a residual portion of the aneurysm is identified. This technique also provides some advantages, such as immediate vasospasm identification and treatment with intra-arterial vasodilators, balloon proximal control for certain paraclinoid aneurysms, and simultaneous endovascular treatment in selected cases during a single stage.

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References

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