Single-center Retrospective Analysis of One-stop Hybrid Surgery for Brain Arteriovenous Malformations

Objectives To evaluate the safety and effectiveness of one-stop hybrid surgery of microsurgical resection combined with preoperative embolization or intraoperative angiography for brain arteriovenous malformations (bAVMs) and compare the efficacy of one-stop hybrid surgery with nonhybrid surgery (endovascular embolization alone) in the treatment of bAVMs. Methods A single-center retrospective study was performed to recruit 70 patients with bAVMs at our hospital between July 2017 and April 2020. Patients were divided into 2 groups depending on the mode of surgery: hybrid group (i.e., microsurgical resection combined with preoperative endovascular embolization or intraoperative angiography in the hybrid operating room), and nonhybrid group (i.e., endovascular embolization, stereotactic radiosurgery, or microsurgical resection alone). The hybrid group was divided into two subgroups: the microsurgical resection combined with preoperative embolization, and the microsurgical resection combined with intraoperative angiography subgroups. All patients’ demographic variables, clinical manifestations, and imaging features, postoperative complications, and long-term clinical prognosis were recorded and analyzed. Results Among 70 patients, 48 (68.6%) of whom presented cerebral hemorrhage due to bAVMs rupture. 36 (51.4%) patients in the hybrid group were treated with the combination of pre-operative embolization or intraoperative angiography combined with microsurgical resection, whereas 34 (48.6%) in the nonhybrid group underwent embolization alone. There was no statistical difference in gender, age, ruptured bAVM rate, Spetzler-Martin grades between the 2 groups. Regular clinical and radiological follow-up examinations cure rates were 94.4% in the hybrid group compared to 38.3% in the nonhybrid group (P<0.01). The percentage of patients with favorable outcomes was 94.1% in the hybrid group and 90.6% in the nonhybrid group, although this difference was not statistically significant. Conclusions One-stop hybrid surgery could be a safe and effective intervention to treat bAVMs clinically, whereas further follow-up is needed to determine the long-term effects after operation.