One-Stage Treatment in a Hybrid Operation Room to Cure Brain Arteriovenous Malformation: A Single-Center Experience

Jianping Song; Peiliang Li; Yanlong Tian; Qingzhu An; Yingjun Liu; Zixiao Yang; Liang Chen; Kai Quan; Yuxiang Gu; Wei Ni; Wei Zhu; Ying Mao

doi:10.1016/j.wneu.2020.11.123

One-Stage Treatment in a Hybrid Operation Room to Cure Brain Arteriovenous Malformation: A Single-Center Experience

World Neurosurg. 2021 Mar:147:e85-e97. doi: 10.1016/j.wneu.2020.11.123. Epub 2020 Dec 19.

Authors

Jianping Song¹, Peiliang Li¹, Yanlong Tian¹, Qingzhu An¹, Yingjun Liu¹, Zixiao Yang¹, Liang Chen¹, Kai Quan¹, Yuxiang Gu¹, Wei Ni¹, Wei Zhu², Ying Mao¹

Affiliations

¹ Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.
² Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China. Electronic address: drzhuwei@fudan.edu.cn.

PMID: 33348099
DOI: 10.1016/j.wneu.2020.11.123

Abstract

Objective: To report the principles and techniques of using a hybrid operation room in the treatment of brain arteriovenous malformation (BAVM).

Methods: From October 1, 2016 to December 31, 2018, we treated 54 consecutive patients with nonemergent BAVM in a hybrid operation room. The clinical data, radiologic images, and outcomes were collected to establish a prospective database for evaluation.

Results: Thirty-two male and 22 female patients were enrolled with a mean age of 32.6 ± 13.1 years (range, 10-61 years). Bleeding (n = 32, 59.3%) was the main clinical presentation, followed by headache (n = 27, 50.0%), seizures (n = 14, 25.9%), neurofunctional deficits (n = 16, 29.6%), and no symptoms (n = 2, 3.7%). Thirty-one patients (57.4%) accepted resection without intraoperative embolization, 18 (33.3%) were treated with combined embolization and resection, and 5 (9.3%) were cured with intraoperative embolization and resection was cancelled. All patients achieved total BAVM obliteration confirmed with intraoperative angiography. There were no significant differences in outcomes between low-grade (Spetzler-Martin grades I, II, and modified grade III-) and high-grade (Spetzler-Martin grades ≥IV and modified grade III+) groups, except that the high-grade group had more blood loss (667.9 ± 647.5 vs. 284.3 ± 148.6 mL; P = 0.046) and longer postoperative hospitalization (17.1 ± 9.1 vs. 10.8 ± 5.4 days; P = 0.026). At discharge, 52 patients (96.3%) had favorable outcomes (Glasgow Outcome Scale score ≥4). Forty-three patients (79.6%) received 1 year follow-up after treatment; 97.7% (n = 42) of these had ongoing favorable outcomes. However, 4 patients with low-grade BAVM had recurrence.

Conclusions: The hybrid operation room can ensure safe, comprehensive treatment of BAVM, offering the opportunity for a favorable curative treatment in 1 stage.

Keywords: Brain arteriovenous malformation; Endovascular treatment; Hybrid operation room; Surgery.

MeSH terms

Adolescent
Adult
Arteriovenous Fistula / diagnostic imaging*
Arteriovenous Fistula / surgery*
Child
Cohort Studies
Female
Follow-Up Studies
Humans
Intracranial Arteriovenous Malformations / diagnostic imaging*
Intracranial Arteriovenous Malformations / surgery*
Male
Middle Aged
Operating Rooms / methods*
Prospective Studies
Treatment Outcome
Young Adult