One-stop hybrid operation versus microsurgery for treating brain arteriovenous malformation in children-a retrospective case series

Abstract

Background: Brain arteriovenous malformation (BAVM) is one of the most common causes of cerebral hemorrhage in children. The effectiveness of one-stop hybrid operation in the treatment of BAVM in adults has been widely confirmed, but there are few study for the case in children. The aim of this study was to retrospectively analyze of the role and significance of one-stop hybrid surgery versus microsurgery in the treatment of BAVM in children.

Methods: A total of 57 children (≤18 years old) with BAVM who were admitted to The 900th Hospital and Fujian Children's Hospital between September 2018 and August 2022 were retrospectively analyzed. According to the inclusion and exclusion criteria, 38 patients were included, and they were divided into a microsurgical group (25 patients) and a hybrid operation group (13 patients) according to the treatment modality. The following clinical characteristics were observed: sex, age, initial symptoms, presence or absence of signs, Glasgow Coma Scale (GCS) score, Hunt-Hess grade, imaging characteristics such as the location of the BAVM, Spetzler-Martin (S-M) grade, presence of intraventricular hemorrhage, treatment and prognostic indicators such as intraoperative blood loss, operation time, imaging cure, postoperative complications, length of hospital stay, and 3- and 6-month modified Rankin score (mRS) after the operation.

Results: The proportions of female patients (P=0.042), patients whose BAVM were located in the supratentorial region (P=0.034) and patients whose S-M grade was above grade III (P=0.003) were greater in the hybrid operation group than those in the microsurgical group. The intraoperative blood loss (P<0.001), operation time (P<0.001) and postoperative hospital stay (P=0.024) of patients in the microsurgical group were greater than those in the hybrid operation group. The presence of signs and the S-M grade may be relevant factors in predicting the surgical approach, and the probability of selecting a hybrid operation for each step of increasing the S-M grade was 3.046 times that of microsurgery.

Conclusions: A one-stop hybrid operation is effective and safe for the treatment of BAVM in children. High S-M grades of BAVM are more suitable for hybrid operation.

Keywords: One-stop hybrid operation; brain arteriovenous malformation (BAVM); case series; children; microsurgery.

Figure 1

The inclusion criteria and exclusion criteria for the study on BAVM. BAVM, brain arteriovenous malformation.

Figure 2

A case of BAVM underwent hybrid operation. (A,B) DSA showed BAVM at right frontal lobe, supplied by the anterior and middle cerebral arteries, draining to the superior sagittal sinus. (C,D) BAVM residual after partial embolization. (E) BAVM resection under microscope. (F,G) Postoperative DSA showed BAVM completely removed. (H) Postoperative CT follow-up imaging. BAVM, brain arteriovenous malformation; DSA, digital subtraction angiography; CT, computed tomography.