Hybrid operating rooms are initiating a new era in the healthcare sector by seamlessly integrating traditional surgical methods with the most modern medical imaging and navigation technologies. Within the Liv Hospital Brain and Nerve Surgery Clinic, hybrid operating room systems are utilized across a broad spectrum of diseases and complex trauma interventions in brain, spinal cord, and spine surgeries. This high-level technological infrastructure provides surgeons with an unparalleled zone of control and safety, particularly in neurovascular procedures such as aneurysm and arteriovenous malformation treatments, brain tumor resections, functional stereotactic surgeries, and spinal implantations.

O-Arm CT Imaging System for Intraoperative Scanning

Representing a next-generation medical imaging technology, the mobile tomography device known as the O-Arm allows for intraoperative computed tomography (CT) scans during surgery. It provides real-time 3D or 2D imaging during both brain and spine operations. The device completes a full 360-degree, three-dimensional scan in an exceptionally short timeframe of just 13 seconds. Equipped with robotic positioning capabilities that rapidly align with the operating table, this system delivers the same high image quality as standard CT scanners by capturing a comprehensive scan in a single pass. Furthermore, it performs this process with one-third of the traditional radiation exposure, creating a continuous and safe monitoring environment throughout the procedure.

Operating Principle

The O-Arm system operates on the core principle of pulsed fluoroscopy combined with advanced 3D volumetric reconstruction algorithms. The mobile gantry rotates around the patient, capturing hundreds of highly detailed 2D projections. Internal software immediately processes these projections into a comprehensive three-dimensional dataset. This mechanism allows the surgical team to verify the exact anatomical placement of hardware in real time without waiting for postoperative imaging.

Specific Surgical Applications

  • Complex spinal fusion procedures
  • Correction of severe and rigid childhood or adolescent spinal curvatures
  • High-risk pedicle screw placements in deformed spines
  • Excision of complex bone tumors located in the spinal column
  • Interventions for developmental disorders of the spine
  • Spinal instrumentation for trauma-related fractures and dislocations

Spinal instrumentation surgeries performed under the 3D imaging guidance of O-Arm technology aim to maximize the success rate while reducing the margin of anatomical error to zero. Surgical success is further maximized when integrated with the neuro-navigation system, which pinpoints all targets with millimetric precision. During the procedure, the risk of damaging the spinal cord and nerve roots is eliminated with a high-precision margin of one or two millimeters, rendering the operation exceptionally safe. Thanks to the O-Arm CT system, a final control scan is conducted under completely sterile conditions at the concluding stage of the surgery, minimizing the likelihood of unexpected complications that might require revision surgery. Through this innovative approach, patients mobilize much faster and experience shorter hospital stays.

Clinical Advantages of the O-Arm System

  • Substantially lowers the risk of revision surgeries by constantly providing the surgeon with critical, real-time data at every stage.
  • Ensures the patient is exposed to significantly lower levels of radiation compared to traditional methods.
  • Allows for smaller surgical incisions, thereby reducing blood loss and accelerating the postoperative recovery process.
  • Minimizes the potential risk factors inherently associated with complex surgical interventions.
  • Lowers the risk of postoperative infections and reduces the probability of screw-related paralysis to the absolute minimum.

High Precision with the Neuro-Navigation System

Functioning as an advanced global positioning system for targets within the brain and spinal cord, neuro-navigation technology calculates precise coordinates to present the surgeon with three-dimensional, real-time images. Through this system, target lesions in neurosurgery are approached with sub-millimeter precision. Consequently, the possibility of damaging healthy tissue surrounding the target area is meticulously prevented. Prior to surgery, MRI or CT scans obtained from the patient are transferred to the navigation device. This data transfer allows various high-risk zones within the brain and spinal anatomy to be visualized via real-time navigation, enabling flawless surgical planning.

Operating Principle

This technology relies primarily on advanced optical tracking mechanisms. An integrated infrared camera continuously detects specialized reflective markers attached to both the patient anatomy and the surgical instruments. The system software computationally aligns these physical spatial coordinates with the preoperative digital MRI or CT datasets. Consequently, the surgeon views the exact trajectory of their instruments on the digital anatomical map in real time.

Specific Surgical Applications

  • Deep Brain Stimulation (DBS) electrode placement for Parkinson disease
  • Transsphenoidal microscopic resections of pituitary adenomas
  • Targeted stereotactic biopsies of deep-seated brain lesions
  • Resection of tumors located in highly functional and eloquent brain areas

For small and deep-seated tumors or similar lesions, stereotactic biopsies can be successfully performed through a minimal entry burr hole. A fine medical needle is directed straight to the target to extract a precise tissue sample, and the detailed pathological analysis of this sample plays a critical role in determining the most optimal treatment protocol for the patient.

Surgical Benefits of the System

  • Helps actively avoid critical neural structures by providing flawless guidance over delicate anatomy.
  • Expands the boundaries of minimally invasive surgery, facilitating shorter operation times through smaller incisions.
  • Maximizes the preservation of the patient healthy anatomical structure, thereby increasing the overall safety of the surgical intervention.

Next-Generation Fluorescence-Filtered Microscope

Equipped with specialized light filters, next-generation surgical microscopes possess the capability to definitively distinguish fluorescently dyed tumor tissue from normal, healthy neural tissue. When this advanced microscope technology is integrated with neuro-navigation devices, it ensures maximum tumor resection with minimum error through a significantly smaller incision. In addition to tumor operations, this system demonstrates high clinical efficacy in cerebrovascular surgeries.

Operating Principle

The fundamental working mechanism depends on targeted optical excitation. During the procedure, the surgical field is illuminated with a highly specific wavelength of light. Administered contrast agents or fluorophores absorb this light and subsequently emit a distinct visible color. This biochemical reaction creates a sharp visual contrast between pathological tissues or vascular structures and the surrounding healthy neural anatomy.

Specific Surgical Applications

  • Microvascular clipping of cerebral aneurysms
  • Maximal safe resection of high-grade gliomas such as glioblastoma
  • Extracranial-intracranial bypass surgeries
  • Excision of highly vascularized arteriovenous malformations

After a specific fluorescent agent is administered intravenously to the patient during the operation, the microscope filter is adjusted to clearly visualize the cerebral vascular structure. This innovative procedure effectively functions as a simultaneous intraoperative cerebral angiography right on the operating table. The surgical team can observe the intricate cerebral vascular network in detail before the surgery concludes, directly enhancing the safety of surgical interventions for cerebrovascular diseases.

Intraoperative Neuromonitoring (IONM)

Intraoperative Neuromonitoring is a vital safety system developed to minimize the risk of nerve damage during brain tumor resections and complex spine surgeries. Throughout the operation, specific electrical stimuli are delivered via electrodes placed on the patient scalp and muscles. Through this technology, the brain, spinal cord, nerve roots, and reflex pathways are continuously monitored on a medical screen.

Operating Principle

The system functions by objectively quantifying electrical signal conduction along the central and peripheral nervous systems. By utilizing stimulating and recording electrodes, it measures Somatosensory Evoked Potentials and Transcranial Motor Evoked Potentials. This continuous neurophysiological data stream evaluates the integrity of sensory and motor pathways, immediately highlighting any conduction delays or amplitude drops that signify potential nerve distress.

Specific Surgical Applications

  • Excision of intramedullary spinal cord tumors
  • Tethered cord release surgeries
  • Microvascular decompression for trigeminal neuralgia
  • Complex spinal deformity corrections

If any physiological deviation or alteration occurs in the tracked neurophysiological signals, a specialized neurologist overseeing the monitoring system immediately informs the surgeon. This proactive safety measure prevents irreversible neurological deficits, safeguards the patient quality of life, and ensures a much faster return to daily routines following recovery.