Abstract：
Complex cerebral arteriovenous malformations (AVMs) require a combined therapy of endovascular embolization and microsurgical resection to eliminate the lesion and maximize neurological protection, while a deliberate time interval might contribute to optimal clinical outcomes. The present study aimed to explore the feasibility of this paradigm.
All patients who underwent deliberately planned presurgery embolization and microsurgery resection between 2015 and 2023 were reviewed, with baseline data, postoperative complications, and follow-up outcomes recorded. The modified Rankin scale (mRS) was used to evaluate clinical outcomes, with mRS 0-2 defined as good.
A total of 30 patients were included in the study (15 were ruptured AVMs). The median Spetzler-Martin grade of baseline AVMs was 3 (interquartile range: 2-3). The median interval between the last embolization and microsurgery was 5 days (interquartile range: 2.25-7). The complete removal rate was 100%, and the overall permanent complication rate was 16.67%. At the last follow-up, 26 patients achieved mRS 0-2, while 28 had improved or unaltered mRS. The last follow-up mRS significantly improved from baseline and discharge (P = 0.0006 and P = 0.006). The last follow-up mRS decreased by 0.65 for each additional day of time interval before the 4.4-day inflection point (β = -0.65, P = 0.02) in the AVM ruptured cohort.
The deliberately staged combined procedure of embolization and microsurgery might be a safe and efficacious strategy for Spetzler-Martin grade 2-5 AVMs, 4-5 days might be an appropriate staged time interval for ruptured AVMs, although further studies are needed to substantiate these findings.
All patients who underwent deliberately planned presurgery embolization and microsurgery resection between 2015 and 2023 were reviewed, with baseline data, postoperative complications, and follow-up outcomes recorded. The modified Rankin scale (mRS) was used to evaluate clinical outcomes, with mRS 0-2 defined as good.
A total of 30 patients were included in the study (15 were ruptured AVMs). The median Spetzler-Martin grade of baseline AVMs was 3 (interquartile range: 2-3). The median interval between the last embolization and microsurgery was 5 days (interquartile range: 2.25-7). The complete removal rate was 100%, and the overall permanent complication rate was 16.67%. At the last follow-up, 26 patients achieved mRS 0-2, while 28 had improved or unaltered mRS. The last follow-up mRS significantly improved from baseline and discharge (P = 0.0006 and P = 0.006). The last follow-up mRS decreased by 0.65 for each additional day of time interval before the 4.4-day inflection point (β = -0.65, P = 0.02) in the AVM ruptured cohort.
The deliberately staged combined procedure of embolization and microsurgery might be a safe and efficacious strategy for Spetzler-Martin grade 2-5 AVMs, 4-5 days might be an appropriate staged time interval for ruptured AVMs, although further studies are needed to substantiate these findings.
摘要：
目的：复杂的脑动静脉畸形（AVM）需要血管内栓塞和显微外科切除的联合治疗，以消除病变并最大程度地保护神经系统。而故意的时间间隔可能有助于最佳的临床结局。本研究旨在探讨这一范式的可行性。
方法：对所有在2015年至2023年之间进行了有意计划的术前栓塞和显微手术切除的患者进行了回顾，有了基线数据，术后并发症,并记录随访结果。采用改良Rankin量表(mRS)评价临床结局,mRS0-2定义为良好。
结果：本研究共纳入30例患者（15例AVM破裂）。基线AVM的中值Spetzler-Martin等级(SM)为3(四分位距[IQR]:2-3)。末次栓塞和显微手术之间的中位间隔为5天(IQR:2.25-7)。完全去除率为100%，总的永久性并发症发生率为16.67%。在最后一次随访中，26例患者达到mRS0-2，而28例mRS改善或未改变。末次随访mRS较基线和出院时显著改善(P=0.0006和P=0.006)。在AVM破裂队列中，在4.4天的拐点（β=-0.65，P=0.02）之前，每增加一天的时间间隔，最后一次随访mRS降低0.65。
结论：故意分期的栓塞和显微外科手术联合手术可能是SM2-5AVM的安全有效策略，尽管需要进一步的研究来证实这些发现，但4-5天可能是AVMs破裂的适当分期时间间隔。
方法：对所有在2015年至2023年之间进行了有意计划的术前栓塞和显微手术切除的患者进行了回顾，有了基线数据，术后并发症,并记录随访结果。采用改良Rankin量表(mRS)评价临床结局,mRS0-2定义为良好。
结果：本研究共纳入30例患者（15例AVM破裂）。基线AVM的中值Spetzler-Martin等级(SM)为3(四分位距[IQR]:2-3)。末次栓塞和显微手术之间的中位间隔为5天(IQR:2.25-7)。完全去除率为100%，总的永久性并发症发生率为16.67%。在最后一次随访中，26例患者达到mRS0-2，而28例mRS改善或未改变。末次随访mRS较基线和出院时显著改善(P=0.0006和P=0.006)。在AVM破裂队列中，在4.4天的拐点（β=-0.65，P=0.02）之前，每增加一天的时间间隔，最后一次随访mRS降低0.65。
结论：故意分期的栓塞和显微外科手术联合手术可能是SM2-5AVM的安全有效策略，尽管需要进一步的研究来证实这些发现，但4-5天可能是AVMs破裂的适当分期时间间隔。
