Hybrid Biplane Neurosurgical Operating Room

A hybrid biplane neurosurgical operating room is a modern surgical environment made to combine advanced imaging technology with traditional neurosurgical practices. This allows surgeons to diagnose & treat complex brain/spine conditions in real time, the OR (operating room) being designed around the idea that surgery and imaging have the capability to work together simultaneously to improve accuracy, safety, and outcomes. The “hybrid” term in the name is used to refer to the combination of a fully functioning OR with high-power imaging systems. “Biplane” refers to how the room using two imaging planes, capturing images from different angles at the same time. These features help surgeons look closely at our delicate neural structures, allowing for them to act with as much precision as possible while they operate. 

(Dreesen, 2024)

The biplane angiography system is the core of a hybrid biplane neurosurgical operating room. It allows for use of two X-ray sources with detectors at various angles, producing three dimensional photos of blood vessels, brain tissue, and other surrounding anatomy. Biplane imaging lets surgeons see exactly what’s happening as they do it, unlike standard imaging that’s taken before and/or after surgery and not providing useful feedback throughout surgery. This live feedback is essential for advanced surgery because of how small distances/changes can cause critical preservation or damage. Being able to view structures in multiple dimensions reduces risk of having to repeat imaging or repeat surgery. 

Extensive preoperative planning is still required before a patient ever enters the hybrid operating room. Surgeons analyze detailed scans of the brain or spine to map out blood vessels, nerves, and areas of concern. However, the advantage of the hybrid biplane setup becomes most apparent once the surgery begins. After the patient is carefully positioned and secured, sterile imaging equipment is brought into place without disrupting the surgical field. Surgeons can then confirm anatomical landmarks, track surgical instruments, and monitor blood flow throughout the procedure. This continuous imaging guidance is particularly useful during vascular neurosurgeries, such as aneurysm repair, arteriovenous malformation treatment, or stroke-related interventions.

In surgery, minimally invasive techniques are used most commonly in a hybrid biplane neurosurgical operating room. Catheters, guidewires, and many other microsurgical tools are inserted through small incisions and navigated toward the target area as surgeons observe their progress on high-definition monitors. This biplane system allows for consistent verification that medical instruments are moving safely around important structures such as that of the nervous system. If adjustments are needed, surgeons can make them immediately instead of discovering the issue after completion of the procedure. This real-time adaptability significantly reduces the likelihood of complications and the need for follow-up surgeries.

Once the primary surgical objective is completed, the imaging system is again used to confirm success. Surgeons can immediately verify that a tumor has been fully removed, an aneurysm has been sealed, or blood flow has been restored properly. This final inspection step is a crucial advantage of the hybrid operating room, as it provides reassurance that no residual issues remain before the patient is closed and moved to recovery. The room is then carefully reset, with imaging equipment retracted and surgical sites closed using the same level of precision applied throughout the operation. Hybrid biplane neurosurgical operating rooms represent a significant advancement in how complex neurological procedures are performed overall. By combining real-time, multi-angle imaging with meticulous surgical technique, it allows surgeons to operate with greater confidence and control. The integration of these technologies ultimately prioritizes patient safety, minimizes invasiveness, and enhances the ability to treat conditions within one of the most delicate systems of the human body.

Written by Kamila Dessus at Incisionary

References:

Breakthroughs for Physicians. (2025, October 20). Tour the Hybrid Biplane Neurosurgical OR at Northwestern Medicine. YouTube. https://www.youtube.com/watch?v=ypbVKTKz6As 

Center, M. (2025, June 23). ARMC Breaks Ground on State-of-the-Art Hybrid Bi-Plane Angiography Suite and Operating Room. Arrowhead Regional Medical Center. https://www.arrowheadregional.org/news-blog/2025/june/armc-breaks-ground-on-state-of-the-art-hybrid-bi/ 

dreesen, stefan. (2024, October 3). Canadian first: Hybrid biplane OR to maximize efficiency and patient safety. Hospital News. https://hospitalnews.com/canadian-first-hybrid-biplane-or-to-maximize-efficiency-and-patient-safety/ 

Gharios, M., Victor Gabriel El-Hajj, Frisk, H., Ohlsson, M., Omar, A., Edström, E., & Elmi-Terander, A. (2023). The use of hybrid operating rooms in neurosurgery, advantages, disadvantages, and future perspectives: a systematic review. Acta Neurochirurgica. https://doi.org/10.1007/s00701-023-05756-7 

Optimal design of neurosurgical hybrid operating room - Surgical Neurology International.  (2021). Surgical Neurology International. https://surgicalneurologyint.com/surgicalint-articles/optimal-design-of-neurosurgical-hybrid-operating-room/ 

Page Restricted. (2026). P2sinc.com. https://p2sinc.com/case-study-stories/hybrid-biplane-operating-room 

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