Transradial catheterization for prone neurosurgical treatment in a hybrid operating room: Technical considerations

Surgical management of cerebrovascular diseases in a hybrid operating room (HOR) is advantageous in patients requiring postoperative cerebral angiography to confirm complete obliteration or in procedures requiring a combined open and endovascular approach. However, in the prone position, conventional transfemoral arterial access is challenging, as the introducer sheath is positioned between the patient and the surgical table, impeding catheter maneuverability. This case series outlines the technical details and potential advantages of the transradial approach in patients undergoing cerebrovascular surgery in the prone position.

Case 1 - A 55-year-old man was admitted with a subarachnoid hemorrhage. Cerebral angiography revealed a ruptured fusiform aneurysm at the origin of the left posterior inferior cerebellar artery (PICA). A hybrid surgical strategy consisting of an occipital artery-PICA bypass followed by endovascular internal trapping of the aneurysm was planned. Because the left radial artery puncture site was located on the dorsal surface near the operator with the patient in the prone position, catheter manipulation was more straightforward than with the conventional transfemoral approach. The procedure was completed without complications, except a cerebral infarction related to internal trapping. Case 2 - A 78-year-old man presented with a subarachnoid hemorrhage and was subsequently diagnosed with a craniocervical junction arteriovenous fistula. The draining vein was ligated with the patient in the prone position. Intraoperative cerebral angiography through the left radial artery confirmed complete shunt occlusion.

The transradial approach is technically advantageous in prone-position procedures in the HOR; it facilitates catheter manipulation during complex cerebrovascular surgeries.