[Combined surgical and endovascular treatments of complex cerebral arteriovenous malformation in hybrid operating room].

ABSTRACT

OBJECTIVE: To summarize the clinical experiences of microsurgical and endovascular treatments of complicated arteriovenous malformation (AVM) in the conditions of hybrid operating room. METHODS: The clinical data were collected and analyzed for 8 patients of complex AVM between June 2012 to June 2013. There were Spetzler grade III (n = 2) and grade IV (n = 6). And the lesions were complicated with intracranial aneurysms (n = 3) and located in motor area (n = 2) and basal ganglia (n = 2). Five cases of AVM with cerebral hemorrhage underwent emergency surgery, including digital subtraction angiography (DSA) plus intraoperative embolization plus surgical resection of AVM plus intraoperative DSA (iDSA). Two cases underwent embolization plus aneurysm surgery while another had AVM embolization plus AVM resection and γ knife treatment. RESULTS: All surgical procedures, including iDSA, were completed in the same hybrid operating room. There was no change of surgical position or intraoperative mortality. Five patients of AVM hemorrhage undergoing emergency hematoma evacuation had no residue of AVM on iDSA. Their postoperative consciousness improved without neurological dysfunction. Two patients of limb paralysis recovered to paresis at 3 months postoperation. One case with blurry vision improved somewhat. Two cases undergoing elective surgery had a complete resection of AVM after embolization. CONCLUSION: Surgery plus endovascular treatment in hybrid operating room is efficacious for complex cerebral AVM. It avoids multiple surgeries and inspections. And any lesion residue may be assessed immediately with postoperative DSA.