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.
■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。