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The preliminary investigation of application of single-staged hybrid operation in treatment of complex cerebral arteriovenous malformation

Jun Wen, Xiangyu Wang, Chengyou Yang

Objective: To explore the feasibility and treatment strategy of application of single-staged endovascular embolization combined surgical resection for complex cerebral arteriovenous malformations (AVM).

Methods: The clinical data of 11 cases of patients with complex cerebral AVM treated by single staged endovascular embolization combined surgical resection were analyzed. AVM was graded using the Spetzler-Martin grading system. The preoperative neurological score was rated according to the Glasgow Coma Scale (GCS) scoring system. The postoperative images were obtained by DSA or enhanced CT and CTA. The clinical follow-up was conducted by a modified Rankin scale.

Results: The clinical data of a total of 11 patients were collected. Eight patients were scored 15 by the preoperative GCS, one patient 13, one patient 11, and one patient 6. Four patients were graded 2 by the Spetzler-Martin grading system, three patients 3, three patients 4, and one patient 5. Intraoperative angiography confirmed that the immediate imaging cure rate reached 100%, of which AVM residue was found in 3 cases in the intraoperative angiography. After one-stage re-resection, it was confirmed that malformations were completely not developed. Postoperative re-bleeding was not found in any cases. All patients were followed up. After 3-month follow-up, nine persons were scored 0 by the modified Rankin scale, and two persons were scored 2. Eight persons received postoperative radiology follow-up, two received CTA, and six received DSA. There was no recurrence.

Conclusion: The hybrid operation of single-staged endovascular embolization combined surgical resection has improved the treatment of complex AVM, reduced the difficulty of treatment and improved the effectiveness and safety of the treatment.