Shi Jichun, Xu Shuangxiang, Feng Yu, Wei Wei, Zou Yichun, Xiong Wenping, Zhao Wenyuan, Zhang Tingbao, Peng Hao, Chen Jincao
Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
Department of Neurosurgery, Hainan Affiliated Hospital of Hainan Medical University (Hainan General Hospital), Haikou, Hainan, China.
Front Med (Lausanne). 2024 Aug 7;11:1446088. doi: 10.3389/fmed.2024.1446088. eCollection 2024.
Intraoperative blood loss poses a great challenge for brain arteriovenous malformation (AVM) microsurgery, although systematic researches are still lacking. This study aimed to identify factors predicting intraoperative major blood loss in brain AVM microsurgery and to investigate its impact on patient outcome. To deal with the fierce bleeding, we introduced a modified hemostatic method, bone-wax (BW) coated bipolar electrocoagulation.
The authors retrospectively analyzed the clinical data of 131 patients (50/81 in intraoperative major/non-major blood loss cohort) with brain AVMs who underwent microsurgery in our center during the period between January 2018 and April 2023. According to previous studies, major blood loss was defined as blood loss of at least 1,000 mL. The accuracy and objectivity of our grouping methodology were validated by comparing the hemoglobin mass loss, hematocrit loss and factors associated with intraoperative bleeding. Potential clinical and radiological predictors for intraoperative major blood loss were evaluated using a multivariate stepwise logistic regression. And outcomes of patients in the two cohorts were also compared. At last, the performance of BW coated bipolar electrocoagulation in brain AVM microsurgery was illustrated by the case presentation, histological staining and transmission electron microscopy of the coagulated nidus vessels.
Hemoglobin mass loss, hematocrit loss and factors associated with intraoperative bleeding were significant different between the two cohorts. five independent factors predicting intraoperative major blood loss were identified: (1) clinical manifestations; (2,3) location and size of the nidus; (4) deep venous drainage; and (5) the number of draining veins. And the intraoperative major blood loss can not only adversely affect the surgical progression, but also predict poor perioperative outcomes for patients. Regarding the application of BW coated bipolar electrocoagulation, we found the novel hemostatic method exerted efficient hemostatic effect and reduced the damage to the vascular structure in brain AVM microsurgery.
This study proposed a nomogram for neurosurgeons to predict intraoperative major blood loss in brain AVM microsurgery preoperatively. And intraoperative major blood loss is associated with poor patient outcomes. In addition, BW coated bipolar electrocoagulation, can be applied to control ferocious bleeding during brain AVM microsurgery, which still remains further researches.
术中失血给脑动静脉畸形（AVM）显微手术带来了巨大挑战，尽管仍缺乏系统性研究。本研究旨在确定预测脑AVM显微手术中术中大出血的因素，并探讨其对患者预后的影响。为应对剧烈出血，我们引入了一种改良的止血方法，即骨蜡（BW）涂层双极电凝。
作者回顾性分析了2018年1月至2023年4月期间在本中心接受显微手术的131例脑AVM患者（术中大出血/未大出血队列分别为50/81例）的临床资料。根据既往研究，大出血定义为失血量至少1000 mL。通过比较血红蛋白质量损失、血细胞比容损失以及与术中出血相关的因素，验证了我们分组方法的准确性和客观性。使用多变量逐步逻辑回归评估术中大出血的潜在临床和影像学预测因素。并比较了两个队列患者的预后。最后，通过病例展示、凝固的畸形血管团血管的组织学染色和透射电子显微镜，阐述了BW涂层双极电凝在脑AVM显微手术中的性能。
两个队列之间的血红蛋白质量损失、血细胞比容损失以及与术中出血相关的因素存在显著差异。确定了五个预测术中大出血的独立因素：（1）临床表现；（2,3）畸形血管团的位置和大小；（4）深部静脉引流；以及（5）引流静脉数量。术中大出血不仅会对手术进程产生不利影响，还可预测患者围手术期预后不良。关于BW涂层双极电凝的应用，我们发现这种新型止血方法在脑AVM显微手术中发挥了有效的止血作用，并减少了对血管结构的损伤。
本研究为神经外科医生提出了一种列线图，用于术前预测脑AVM显微手术中的术中大出血。术中大出血与患者不良预后相关。此外，BW涂层双极电凝可应用于控制脑AVM显微手术中的凶猛出血，这仍有待进一步研究。
