Zeng Chaofan, Wang Mingze, Song Xiaowen, Zhang Chaoqi, Lin Fa, He Qiheng, Yang Wuyang, Cao Yong, Wang Shuo, Tu Wenjun, Zhao Jizong
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ann Transl Med. 2022 Jul;10(13):732. doi: 10.21037/atm-22-811.
To compare the clinical outcomes of hybrid microsurgery and embolization with multi-staged procedure for patients harboring brain arteriovenous malformations (bAVMs).
We retrospectively reviewed bAVM patients from a multicenter, prospectively collected database (NCT03774017) between June 2016 and June 2020. Patients were divided into single-staged hybrid operation (HO) group and multi-staged operation (MO) group according to the received treatment, in which microsurgeries were performed with embolization in a single setting or with multi-stage procedure, respectively. Cases were 1:1 matched between the two groups. Outcomes were compared between groups, which included neurological deficits (NDs), perioperative rupture, and proportion of complete resection. Variables associated with NDs were analyzed.
In total, 198 out of 544 cases were identified, including 120 in the HO group and 78 in the MO group. Sixty-six cases were matched in each group resulting in a total of 132 patients in this case-controlled study. Mean age was 29.2 years old, with 82 (62.1%) being male. No significant difference was observed in baseline demographics and clinical characteristics between the two groups. There were 7 ruptures occurred in the interval between embolization and microsurgery for MO group while none in the HO group (P=0.023). This yielded a rupture risk of 4.1% per year for the MO group. Duration of surgical resection was significantly reduced in HO group (P=0.001). Compared to MO, HO was more favorable to avoid short-term NDs (3.0% 15.2%, P=0.021), but long-term outcomes were similar. The HO modality (OR, 0.110; 95% CI: 0.017-0.737; P=0.023) was confirmed as the protective factor for short-term NDs.
HO is an effective setup to treat complex bAVMs with avoiding interval hemorrhage risk and reducing surgical risk. We also observed overall similar obliteration rate and resulting clinical outcomes between HO and MO.
比较混合显微手术和分期栓塞术治疗脑动静脉畸形（bAVM）患者的临床疗效。
我们回顾性分析了2016年6月至2020年6月期间来自多中心前瞻性收集数据库（NCT03774017）的bAVM患者。根据接受的治疗方法，将患者分为单期混合手术（HO）组和分期手术（MO）组，其中显微手术分别在单次手术中联合栓塞或采用分期手术进行。两组病例按1:1匹配。比较两组的疗效，包括神经功能缺损（NDs）、围手术期破裂和完全切除比例。分析与NDs相关的变量。
共识别出544例病例中的198例，其中HO组120例，MO组78例。每组匹配66例，本病例对照研究共有132例患者。平均年龄为29.2岁，男性82例（62.1%）。两组间基线人口统计学和临床特征无显著差异。MO组在栓塞和显微手术间隔期发生7例破裂，而HO组无破裂发生（P = 0.023）。MO组每年的破裂风险为4.1%。HO组手术切除时间显著缩短（P = 0.001）。与MO组相比，HO组更有利于避免短期NDs（3.0%对15.2%，P = 0.021），但长期疗效相似。HO术式（OR，0.110；95%CI：0.017 - 0.737；P = 0.023）被确认为短期NDs的保护因素。
HO是治疗复杂bAVM的有效方法，可避免间隔期出血风险并降低手术风险。我们还观察到HO组和MO组的总体闭塞率和临床疗效相似。
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