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Abstract：
UNASSIGNED: To compare the clinical outcomes of hybrid microsurgery and embolization with multi-staged procedure for patients harboring brain arteriovenous malformations (bAVMs).
UNASSIGNED: We retrospectively reviewed bAVM patients from a multicenter, prospectively collected database (NCT03774017) between June 2016 and June 2020. Patients were divided into single-staged hybrid operation (HO) group and multi-staged operation (MO) group according to the received treatment, in which microsurgeries were performed with embolization in a single setting or with multi-stage procedure, respectively. Cases were 1:1 matched between the two groups. Outcomes were compared between groups, which included neurological deficits (NDs), perioperative rupture, and proportion of complete resection. Variables associated with NDs were analyzed.
UNASSIGNED: In total, 198 out of 544 cases were identified, including 120 in the HO group and 78 in the MO group. Sixty-six cases were matched in each group resulting in a total of 132 patients in this case-controlled study. Mean age was 29.2 years old, with 82 (62.1%) being male. No significant difference was observed in baseline demographics and clinical characteristics between the two groups. There were 7 ruptures occurred in the interval between embolization and microsurgery for MO group while none in the HO group (P=0.023). This yielded a rupture risk of 4.1% per year for the MO group. Duration of surgical resection was significantly reduced in HO group (P=0.001). Compared to MO, HO was more favorable to avoid short-term NDs (3.0% vs. 15.2%, P=0.021), but long-term outcomes were similar. The HO modality (OR, 0.110; 95% CI: 0.017-0.737; P=0.023) was confirmed as the protective factor for short-term NDs.
UNASSIGNED: HO is an effective setup to treat complex bAVMs with avoiding interval hemorrhage risk and reducing surgical risk. We also observed overall similar obliteration rate and resulting clinical outcomes between HO and MO.
UNASSIGNED: We retrospectively reviewed bAVM patients from a multicenter, prospectively collected database (NCT03774017) between June 2016 and June 2020. Patients were divided into single-staged hybrid operation (HO) group and multi-staged operation (MO) group according to the received treatment, in which microsurgeries were performed with embolization in a single setting or with multi-stage procedure, respectively. Cases were 1:1 matched between the two groups. Outcomes were compared between groups, which included neurological deficits (NDs), perioperative rupture, and proportion of complete resection. Variables associated with NDs were analyzed.
UNASSIGNED: In total, 198 out of 544 cases were identified, including 120 in the HO group and 78 in the MO group. Sixty-six cases were matched in each group resulting in a total of 132 patients in this case-controlled study. Mean age was 29.2 years old, with 82 (62.1%) being male. No significant difference was observed in baseline demographics and clinical characteristics between the two groups. There were 7 ruptures occurred in the interval between embolization and microsurgery for MO group while none in the HO group (P=0.023). This yielded a rupture risk of 4.1% per year for the MO group. Duration of surgical resection was significantly reduced in HO group (P=0.001). Compared to MO, HO was more favorable to avoid short-term NDs (3.0% vs. 15.2%, P=0.021), but long-term outcomes were similar. The HO modality (OR, 0.110; 95% CI: 0.017-0.737; P=0.023) was confirmed as the protective factor for short-term NDs.
UNASSIGNED: HO is an effective setup to treat complex bAVMs with avoiding interval hemorrhage risk and reducing surgical risk. We also observed overall similar obliteration rate and resulting clinical outcomes between HO and MO.
摘要：
■比较混合显微手术和栓塞与多阶段手术治疗脑动静脉畸形（bAVM）患者的临床结果。
■我们回顾性分析了来自多中心的bAVM患者，2016年6月至2020年6月前瞻性收集数据库（NCT03774017）。根据患者接受治疗分为单阶段混合手术(HO)组和多阶段手术(MO)组,其中显微手术在单一设置或多阶段手术中进行栓塞，分别。两组病例1:1匹配。结果进行了组间比较，其中包括神经功能缺损(ND)，围手术期破裂，和完全切除的比例。分析与ND相关的变量。
■总共，在544个病例中，有198个被确认，包括HO组中的120个和MO组中的78个。在这项病例对照研究中，每组66例病例匹配，共132例患者。平均年龄29.2岁,男性82人(62.1%)。两组之间的基线人口统计学和临床特征没有显着差异。MO组在栓塞和显微手术之间的间隔中有7次破裂，而HO组则没有（P=0.023）。这导致MO组每年4.1%的破裂风险。HO组手术切除时间显著缩短(P=0.001)。与MO相比，HO更有利于避免短期NDS（3.0%对15.2%,P=0.021),但长期结果相似.HO模态(OR，0.110；95%CI：0.017-0.737；P=0.023）被确认为短期NDS的保护因素。
■HO是治疗复杂bAVM的有效装置，可避免间期出血风险并降低手术风险。我们还观察到HO和MO之间总体相似的闭塞率和由此产生的临床结果。
■我们回顾性分析了来自多中心的bAVM患者，2016年6月至2020年6月前瞻性收集数据库（NCT03774017）。根据患者接受治疗分为单阶段混合手术(HO)组和多阶段手术(MO)组,其中显微手术在单一设置或多阶段手术中进行栓塞，分别。两组病例1:1匹配。结果进行了组间比较，其中包括神经功能缺损(ND)，围手术期破裂，和完全切除的比例。分析与ND相关的变量。
■总共，在544个病例中，有198个被确认，包括HO组中的120个和MO组中的78个。在这项病例对照研究中，每组66例病例匹配，共132例患者。平均年龄29.2岁,男性82人(62.1%)。两组之间的基线人口统计学和临床特征没有显着差异。MO组在栓塞和显微手术之间的间隔中有7次破裂，而HO组则没有（P=0.023）。这导致MO组每年4.1%的破裂风险。HO组手术切除时间显著缩短(P=0.001)。与MO相比，HO更有利于避免短期NDS（3.0%对15.2%,P=0.021),但长期结果相似.HO模态(OR，0.110；95%CI：0.017-0.737；P=0.023）被确认为短期NDS的保护因素。
■HO是治疗复杂bAVM的有效装置，可避免间期出血风险并降低手术风险。我们还观察到HO和MO之间总体相似的闭塞率和由此产生的临床结果。
