Ran Brauner, Stanislas Smajda, Dorian Chauvet, Sorin Aldea, Simon Escalard, Jean-Philippe Désilles, Hocine Redjem, Amira Al Raaisi, Humain Baharvahdat, William Boisseau, Raphaël Blanc, Michel Piotin
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引用次数: 0
Abstract
Brain arteriovenous malformations (AVMs) pose a significant treatment challenge, with current options including microsurgical resection, endovascular embolization, radiosurgery, or combinations thereof. Here, we present our experience with a curative strategy combining complete endovascular treatment followed by microsurgical resection under the same anesthesia session, without relying on a hybrid operating room.
Methods: We reviewed consecutive AVM patients who underwent endovascular treatment (EVT) and microsurgical resection (MS) in a single anesthesia session (COMBI-AVM protocol) from December 2017 to July 2022. Primary endpoints were angiographic AVM obliteration status and modified Rankin Scale (mRS) score at last follow-up. AVMs were graded by the Spetzler-Martin (SM) system, comparing low-grade (SM-I, SM-II, SM-III with nidus <3cm) and high-grade (SM-III with nidus ≥3cm, SM-IV, SM-V) AVMs.
Results: Of 46 AVM patients, 34 had low-grade (73.9%) and 12 had high-grade (26.1%) AVMs. The protocol feasibility was 100%. Median anesthesia time was 8.7 hours (7.6-10.6 IQR). Complete AVM removal was achieved in 45 patients (97.8%), with no recurrences at late (>6 months) follow-up in any of the 32 patients (71.1%) with available follow-up data. Good clinical outcomes (mRS ≤2) were seen in 91.3% of patients. Disabling treatment-related complications occurred in four patients (8.6%), including one death (2.2%).
Conclusion: Combining maximal endovascular embolization and complete surgical resection in a single session in patients with AVM yielded a high cure rate and low morbidity, especially for low-grade lesions. This technique may make it possible to treat high-grade AVMs previously considered ineligible for surgery and reduce peri-procedural morbidity.
期刊介绍：
World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal''s mission is to:
-To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care.
-To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide.
-To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients.
Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
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