To summarize the experience of using hybrid operating room in the surgical treatment of penetrating skull base injury with transnasal neuroendoscopy or craniotomy.

Six patients with penetrating skull base injury were surgical treated in the Neurosurgery Department of General Hospital of Northern Theater Command within a hybrid operating room from November 2015 to October 2019. Among them, 2 cases were treated by transnasal neuroendoscopic surgery, 1 case by transnasal-oral combined neuroendoscopic surgery, 3 cases by craniotomy. Surgical technique, postoperative complications and GOS scores at 6 months after injury were retrospectively analyzed and summarized.

Foreign bodies were successfully removed and intraoperative DSA showed no cerebral vascular injury in all 6 cases. Postoperative cerebrospinal fluid leakage combined with intracranial infection were detected in 1 case and pulmonary infection in 3 cases. After 6 months of follow-up, 1 case died, 1 case had a long-term coma, 2 cases had mild disability, and 2 cases had non-neurologic defects.

Hybrid operating room equipped with DynaCT-angiography and DSA system can provide real-time, accurate and safe imaging guidance for surgical treatment of penetrating skull base injury. Minimally invasive transnasal neuroendoscopic surgery can be used to treat penetrating skull base injury in some cases.