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.
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.
World Neurosurg. 2021 Mar;147:e85-e97. doi: 10.1016/j.wneu.2020.11.123. Epub 2020 Dec 19.
To report the principles and techniques of using a hybrid operation room in the treatment of brain arteriovenous malformation (BAVM).
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.
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.
The hybrid operation room can ensure safe, comprehensive treatment of BAVM, offering the opportunity for a favorable curative treatment in 1 stage.
报告在杂交手术室治疗脑动静脉畸形（BAVM）中使用混合手术室的原则和技术。
从 2016 年 10 月 1 日至 2018 年 12 月 31 日，我们在杂交手术室治疗了 54 例非紧急 BAVM 连续患者。收集临床资料、影像学图像和结果，建立前瞻性数据库进行评估。
纳入 32 例男性和 22 例女性患者，平均年龄 32.6±13.1 岁（10-61 岁）。出血（n=32，59.3%）是主要临床表现，其次是头痛（n=27，50.0%）、癫痫发作（n=14，25.9%）、神经功能缺损（n=16，29.6%）和无症状（n=2，3.7%）。31 例（57.4%）患者接受无术中栓塞切除术，18 例（33.3%）接受联合栓塞和切除术治疗，5 例（9.3%）术中栓塞后治愈并取消切除术。所有患者均通过术中血管造影证实完全闭塞 BAVM。低级别（Spetzler-Martin 分级 I、II 和改良 III-级）和高级别（Spetzler-Martin 分级≥IV 和改良 III-级）组之间的结局无显著差异，仅高级别组术中出血量更多（667.9±647.5 比 284.3±148.6 mL；P=0.046）和术后住院时间更长（17.1±9.1 比 10.8±5.4 天；P=0.026）。出院时，52 例（96.3%）患者预后良好（格拉斯哥结局量表评分≥4）。43 例（79.6%）患者在治疗后接受了 1 年随访；其中 97.7%（n=42）患者持续预后良好。然而，4 例低级别 BAVM 患者复发。
杂交手术室可确保 BAVM 的安全、全面治疗，为 1 期内的有利治疗提供机会。
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