Intraoperative diagnostics for cerebral aneurysm microsurgery in a hybrid operating room

Intraoperative diagnostics in microsurgery for cerebral aneurysms allows for timely identification and prevention of potential complications. Commonly accepted intraoperative diagnostic methods, such as indocyanine green videoangiography and microvascular doppler ultrasound, are minimally invasive techniques routinely used in aneurysm surgery. CTA and cerebral angiography, which can be applied intraoperatively in a hybrid operating room, are used less frequently and require further study. Purpose. То study intraoperative cerebral angiography and CTA in a hybrid operating room during microsurgery for cerebral aneurysms. Materials and methods. Surgical treatment was performed in a hybrid operating room. The hybrid operating room is equipped with a radiolucent operating table, a robotic angiographic system that allows for a transition to the endovascular surgery stage without compromising sterility, and an intelligent positioning system for the robotic C-arm. The hybrid operating room equipment makes it possible to perform two-dimensional CAG, 3D angiography, and flat-detector CT angiography intraoperatively. During the reporting period, there were 23 microsurgeries for intracranial aneurysms in the hybrid operating room. Results. According to the results of intraoperative flat-detector CT angiography, the position of the clips was satisfactory in 15 patients after microsurgical clipping of cerebral aneurysms. In these cases, radical exclusion of the aneurysm from the bloodstream and the absence of functionally significant stenoses of the aneurysm-carrying arteries and adjacent perforating vessels were diagnosed. In 2 patients (8.7 % of cases), incomplete clipping of the neck of the aneurysm was detected. Conclusions. CTA and cerebral angiography have greater diagnostic value compared to indocyanine green videoangiography and microvascular doppler ultrasound. The hybrid operating room allows for the use of CTA and cerebral angiography intraoperatively, which helps in identifying residual parts of aneurysms, stenoses, and occlusions of functionally important brain vessels at early stages and preventing acute ischemia and hemorrhagic complications.