Hybrid Operating Room for Combined Neuroendovascular and Endoscopic Treatment of Ruptured Cerebral Aneurysms with Intraventricular Hemorrhage.
BACKGROUND
Intraventricular hemorrhages (IVHs) caused by ruptured cerebral aneurysms often have poor outcomes. Treatment challenges include comorbidities, increased intracranial pressure caused by IVH, and risk of rebleeding.


CASE DESCRIPTION
Two cases of severe IVH accompanied by acute hydrocephalus caused by ruptured aneurysm were treated with coil embolization followed by endoscopic hematoma evacuation as a single treatment session in a hybrid operating room (OR) equipped with a multipurpose angio biplane system. The first case was an 84-year-old woman with a ruptured basilar top aneurysm, who presented with Hunt and Hess (H&H) grade 5 subarachnoid hemorrhage (SAH) with packed IVH. The second case was a 43-year-old man with a ruptured anterior communicating artery aneurysm who presented with H&H grade 5 SAH with packed IVH. In both cases, endovascular coil embolization was performed first to prevent intraoperative bleeding. The coiled aneurysms suddenly appeared on the screen of the endoscope during the hematoma removal, which could have led to massive rebleeding if not treated previously. Neither patient needed a reinsertion of the ventricular drainage or developed chronic hydrocephalus during hospitalization. The hybrid OR enabled the 2 treatment approaches to be performed without the need to transfer the patient, thereby minimizing the transition time between the modalities. Intraoperative cone-beam computed tomography contributed to the evaluation of residual clots.


CONCLUSIONS
A hybrid OR may contribute to a combined neuroendoscopic and endovascular treatment for ruptured cerebral aneurysms with severe intraventricular hemorrhage.
['Mori|Ryosuke|R|', 'Yuki|Ichiro|I|', 'Kajiwara|Ikki|I|', 'Nonaka|Yuichiro|Y|', 'Ishibashi|Toshihiro|T|', 'Karagiozov|Kostadin|K|', 'Dahmani|Chiheb|C|', 'Murayama|Yuichi|Y|']
D000328:Adult D000369:Aged, 80 and over D017542:Aneurysm, Ruptured D057510:Endovascular Procedures D005260:Female D006801:Humans D002532:Intracranial Aneurysm D008297:Male D044583:Neuroendoscopy D009873:Operating Rooms D013345:Subarachnoid Hemorrhage D015898:Tomography Scanners, X-Ray Computed
Hybrid operating room Intraventricular hemorrhage Coil embolization Subarachnoid hemorrhage Neuroendoscopy