Application of hybrid operation in the management of acute hemorrhagic cerebral vascular disease

Abstract

Objective To investigate the effectiveness and safety of hybrid surgery (microsurgery combined with intraoperative DSA) in the treatment of acute hemorrhagic cerebral vascular disease. Methods The clinical data, imaging data, treatment and prognosis of 11 patients with acute hemorrhagic cerebral vascular disease treated by hybrid operation from April 2020 to February 2021 in the Anqing First People's Hospital of Anhui Medical University were analyzed. The results showed 3 cases of cerebral arteriovenous malformation (CAVM), including 2 cases located in temporoparietal lobe and one case in right lateral fissure; 2 cases of dural arteriovenous fistula (DAVF) at the base of anterior cranial fossa while fistulaes located in sieve plate; 6 cases of intracranial aneurysms, including 3 cases in the middle cerebral artery (MCA) bifurcation, one case in the pericallosal artery, and 2 cases in the communicating segment of internal carotid artery (ICA). Results All 11 patients completed the surgery successfully, and the success rate was 100%. CAVM resection combined with hematoma removal were performed in 3 cases of CAVM, including one case that intraoperative DSA suggested a little residual malformed mass after initial resection, while DSA reexamination suggested total resection after supplementary resection. Dural arteriovenous fistula resection combined with hematoma removal were performed in 2 cases of anterior fossa, after the fistula was closed, DSA reexamination suggested the arteriovenous fistula disappeared completely. Intracranial aneurysm clipping was performed in 6 cases, DSA showed complete clipping in 4 cases, and complete clipping in 2 cases of aneurysm neck residual after adjustment or aneurysm clip supplement. DynaCT indicated satisfactory final removal of intracranial hematoma in all patients with intracranial hematoma. No patient had serious complications such as rebleeding and cerebral infarction. After a mean follow-up of 8.45 months, modified Rankin Scale (mRS) was 1 in 4 cases and 1 in 2 cases, and 0 in the other 9 cases. All patients underwent at least one CTA or DSA reexamination, and no residual or recurrent vascular lesions were found. Conclusions Hybrid operation as a new treatment mode for acute hemorrhagic cerebral vascular disease is safe and effective, and further accumulation of cases and experience are needed.

doi：10.3969/j.issn.1672⁃6731.2022.07.013