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Clipping of ruptured intracranial aneurysms in a hybrid room environment—a case-control study

  • Original Article - Vascular
  • Published:
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Abstract

Background

Hybrid room treatment (HRT) provides the surgeon immediate intraoperative angiography control of aneurysm occlusion and vessel patency. Since it is relatively resource demanding, in clinical routine HRT is reserved for elective cases. However, since its introduction in our department in 2008, several random cases of ruptured intracranial aneurysms (IAs) have been treated in the HR. This study aims to compare the clinical and radiological outcomes of these cases with cases treated conventionally using a matched pair analysis.

Methods

Twenty (20%) consecutive patients with ruptured IA treated by microsurgical clipping in the HR between 2009 and 2015 were retrospectively matched with “conventionally” (C) treated patients (overall n = 101). Clinical and radiological outcome variables were assessed and compared.

Results

Despite a trend in favor of the HR group, no significant difference between both matched groups (HR vs. C) could be demonstrated regarding the functional outcome (upper/lower good recovery 16/20 vs. 17/20, p > 0.05), frequency of clipping-related vascular insults on CT scans (0/20 vs. 3/20, p > 0.05), aneurysm remnant rate on postoperative angiography (1/20 vs. 4/20, p > 0.05) and retreatment rate (0/20 vs. 1/20, p > 0.05). When cumulating all outcome events by a scoring system, however, the HR cohort showed a significantly lower occurrence of events (p < 0.05). In three cases co-treatment by an endovascular approach was performed in the HR cohort.

Conclusion

In this relatively small cohort, a matched pair analysis revealed a discrete but not significant tendency toward a lower frequency of aneurysm remnants and clipping-related vascular insults in the HR cohort. However, HR cohort patients benefited from direct endovascular co-treatment in selected cases.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of Geneva, Rue Gabrielle Perret-Gentil 4, 1211, Genève 14, Suisse

    Philipp Dammann, Max Jägersberg, Karl Schaller & Philippe Bijlenga

  2. Department of Neurosurgery, University Hospital of Essen, Essen, Germany

    Philipp Dammann

  3. Department of Diagnostic and Interventional Neuroradiology, University Hospital of Geneva, Geneva, Suisse

    Zsolt Kulcsar

  4. Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada

    Ivan Radovanovic

Authors
  1. Philipp Dammann
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  2. Max Jägersberg
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  4. Ivan Radovanovic
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  5. Karl Schaller
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  6. Philippe Bijlenga
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Corresponding author

Correspondence to Philipp Dammann.

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Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Comments

The authors report a small retrospective experience of treating ruptured aneurysms in a hybrid neurovascular operating room from 2009 to 2015. They compared this group with the traditional operating room management using a novel scale designed by the authors that accounts for both the occurrence of a negative outcome and the severity of such an outcome. They have reduced statistical limitations by performing matching of the cohorts and admit to limitations of the cohort size but provide a nuanced analysis of the outcomes using a scale that accounts for the occurrence as well as severity of negative outcomes. This begins to provide data to determine the utility of hybrid operating suites in neurosurgery.

Although they used the hybrid surgical suite, they have limited the application to the diagnosis of suboptimal clip constructs. This study has only considered the diagnostic utility of high-resolution intraoperative angiography and therefore has not leveraged the potential of hybrid treatment techniques. Even after broader adoption of hybrid treatments, centers will need to report on the economic cost and risks of these tools to establish or refute continued use of this technology. The potential for a beneficial economy is there, in that the cost of a stroke or other vascular complication is high, but this solution will need validation before widespread adoption.

Alfred Pokmeng See, Peter Nakaji

Arizona, USA

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Dammann, P., Jägersberg, M., Kulcsar, Z. et al. Clipping of ruptured intracranial aneurysms in a hybrid room environment—a case-control study. Acta Neurochir 159, 1291–1298 (2017). https://doi.org/10.1007/s00701-017-3212-2

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  • DOI: https://doi.org/10.1007/s00701-017-3212-2

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