Application of hybrid operation in children with cerebral arteriovenous malformation

Abstract

Objective To explore the value of hybrid surgery in children with cerebral arteriovenous malformation (CAVM). Methods Nineteen cases of pediatric CAVM from December 2015 to December 2019 were included. After the preoperative enhanced MRI and CTA, MRA or DSA examination confirmed the diagnosis, the hybrid surgery (craniotomy combined with endovascular embolization and intraoperative real⁃time DSA) were performed. Operative time, intraoperative blood loss, hospital stays and perioperative complications were recorded. The modified Rankin Scale (mRS) was used to evaluate prognosis 6 months later after surgery. Results In 19 CAVM cases, 2 cases were Spetzler ⁃ Martin grade Ⅰ, 5 cases were grade Ⅱ, 7 cases were grade Ⅲ and 5 cases were grade Ⅳ, and 4 cases dense type, 4 cases intermediate type and 11 cases diffuse type. The average operative time was (307.21 ± 115.64) min and intraoperative blood loss was 150 (100, 260) ml. Intraoperative endovascular embolization was performed in one case, the DSA after CAVM resection revealed 3 cases with residual malformations, and the final DSA cure rate was 100% (19/19). One patient presented with transient nominal aphasia, one with left limb hemiplegia, one with pulmonary infection, and one with epileptic seizure. Average hospital stays was (15.74 ± 5.04) d, followed ⁃ up time was 32 (20, 40) months. Sixteen patients had good prognosis (mRS score < 2), and 3 patients had poor prognosis (mRS score ≥ 2). There were no cases of rebleeding or recurrence. Conclusions Hybrid surgery can safely and effectively improve the cure rate of CAVM in children, especially for children with complex structure and diffuse type or with previous treatment.DOI：10.3969/j.issn.1672⁃6731.2020.04.009