Hybrid surgery for pediatric neurosurgery: Preliminary experiences of a single center

Abstract

Background: The real-time image-guided system can aid us in localization for complex neurological diseases. Aim: The study aimed to survey the advantages and novel techniques of hybrid surgery in pediatric neurosurgery. Methods: Study design involves a retrospective cohort study. At our hybrid operation room (OR), 10 children at the ages from 16 months to 17 years underwent brain or spine surgery. Eight of them received procedures assisted with real-time images of flat-panel detector (FD)-based computed tomography, DynaCT: three patients underwent cerebrospinal fluid diversions, three frameless stereotactic aspirations (brain abscess 2, intracerebral hemorrhage 1), one frameless stereotactic skull and sinus biopsy, and one spine and neck surgery. Two of them received intraoperative digital subtraction angiography and three-dimensional rotational angiography (3D-RA) for arteriovenous malformation surgery. Results: All of our patients tolerated the whole procedures well. Frameless stereotactic aspiration with navigation was performed for one patient with brain abscess first, but the abscess progressed with mass effect later. The child underwent frameless stereotactic aspirations at the hybrid OR and recovered well within 2 weeks. One patient having neck and high cervical spinal lipoblastoma with the presentation of stridor received surgeries twice before. The patient was quite well without airway compression after tumor resection as maximal as possible with safety at the hybrid OR. Conclusions: For the treatment of complex neurological diseases in children, hybrid surgeries can be considered to be feasible, good alternative, or salvage surgical procedures.