Combined Endovascular and Microsurgical Treatment of Arteriovenous Malformations in the Hybrid Operating Room

Grüter, Basil E.; Mendelowitsch, Itai; Diepers, Michael; Remonda, Luca; Fandiño, Javier; Marbacher, Serge

doi:10.1016/j.wneu.2018.05.241

Cited by 41 publications

(48 citation statements)

References 23 publications

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“…It is necessary to comprehensively evaluate the risk factors and status of patients with cerebral arteriovenous malformation bleeding in the clinic and to actively deal with the significant risk factor of bleeding so as to reduce the risk of disability and death caused by such. With the development of new technology, more and more scholars have considered multidisciplinary and comprehensive treatment in the hybrid operating room [9]. In order to improve the postoperative quality of life and reduce the frequency of complications, we should take active measures to effectively reduce postoperative complications caused by improper nursing, effectively shorten the hospitalization time, and limit hospitalization expenses [10].…”

Section: Discussionmentioning

confidence: 99%

Quality improvement of nursing on patients with complex cerebral arteriovenous malformation undergoing hybrid surgery: a prospective single-center study

2021

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Background We sought to explore an optimal clinical nursing mode following a hybrid surgery for cerebral arteriovenous malformation. Methods Patients with complex cerebral arteriovenous malformations seen in our neurosurgery department from January 2016 to December 2017 were prospectively enrolled. The hybrid surgery protocol included “angiographic diagnosis, surgical resection, and intraoperative angiographic evaluation” and “angiographic diagnosis and embolization, surgical resection, and intraoperative angiographic evaluation”. The patients were randomly stratified into intensive care group and routine care group. After surgery, intensive or routine care was provided, and the prognosis of patients was evaluated, with a subsequent comparative analysis. Results A total of 109 cases were divided into the routine nursing group (n = 54 cases) and intensive nursing group (n = 55 cases). There were no significant differences between the two groups in baseline data before surgery. Postoperative lung infection in the intensive nursing group was significantly less frequent than those in the routine nursing group (5.5% vs. 18.5%, P=0.039) with pulmonary infection and lower extremity venous thrombosis (5.5% vs. 24.1%, P=0.006). The average hospital stay in the intensive nursing group was 14.4 ± 5.78 days, which was significantly lower than that in the routine nursing group (19.3 ± 6.38 days, P=0.013). At 3 months’ follow-up after surgery, the Generic Quality of Life Inventory-74 (GQOLI-74) dimension score and GQOLI-74 total score in the enhanced group were significantly better than those in the routine nursing group (P=0.017 and 0.023, respectively). Conclusions Intensive postoperative nursing can improve the safety of patients after hybrid surgery, reduce the postoperative complications and the average length of hospital stay, and improve the quality of life of patients.

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Section: Discussionmentioning

confidence: 99%

Quality improvement of nursing on patients with complex cerebral arteriovenous malformation undergoing hybrid surgery: a prospective single-center study

2021

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“…However, the increased hemodynamic stress in the remain lesions after invasive treatment for partial nidus may induce an increased hemorrhagic risk in the treatment interval [ 41 ], and pre-radiosurgery embolization has been demonstrated that may cause the lesions divided into distinct compartments, finally inducing a negative impact on obliteration [ 42 ]. Single-stage combined embolization and microsurgery in the hybrid angio-surgical operating room might an efficient strategy for complex bAVMs to reduce the complications in the treatment interval and detect the residual lesions in time [ 43 , 44 ]. In this study, we found that for the same type of bAVMs, the optimal intervention strategy proposed by different subspecialty departments often differ.…”

Section: Discussionmentioning

confidence: 99%

Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

Chen

Meng

et al. 2020

Chin Neurosurg Jl

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Background: In the benefit of the large population and rapid economic growth, the interventional techniques and equipment for brain arteriovenous malformations (bAVMs) in mainland China have been rapidly improved. Chinese neurosurgical cerebrovascular physicians have accumulated rich experience and made pioneering explorations. This study aims to summarize the experience and treatment progress of bAVMs in mainland China. Methods: We performed a web-based nationwide questionnaire survey among 67 tertiary neurosurgical institutions that had acknowledged treating bAVMs in the primary survey. Our questionnaire included clinical characteristics, radiological findings, intervention indications/contraindications, intervention timing, and intraoperative management of different treatment modalities. Results: A total of 63 participants from 49 (73.1%) tertiary neurosurgical institutions responded to our questionnaire. Forty-two (66.7%) were neurosurgeons, 13 (20.6%) were neurointerventionists, and 8 (12.7%) were radiosurgeons. Approximately 3500 to 4000 cases of bAVMs were treated annually in these 49 departments. All participants agreed that the conclusions of ARUBA are debatable. Flow-related aneurysms, deep venous drainage, and arteriovenous fistula were considered as common hemorrhagic risk factors. Unruptured SM IV-V bAVMs, giant bAVMs, pediatric bAVMs, elderly bAVMs, and eloquent bAVMs were not absolute contraindications to intervention. Maximum lesion occlusion and minimal functional impairment were the principles of intervention management. Most of the neurosurgeons and neurointerventionists recommended early intervention (< 30 days) for ruptured bAVMs, and the radiosurgeons suggested intervention in the chronic phase or recovery phase (P < 0.01) and preferably 3 months after bleeding. Multi-modality strategies were thought effective for complex bAVMs, and more exploration of individualized intraoperative management was necessary.

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“…However, the increased hemodynamic stress in the remain lesions after invasive treatment for partial nidus may induce an increased hemorrhagic risk in the treatment interval (41), and pre-radiosurgery embolization has been demonstrated that may cause the lesions divided into distinct compartments, nally inducing a negative impact on obliteration (42). Single-stage combined embolization and microsurgery in the hybrid angio-surgical operating room might an e cient strategy for complex bAVMs to reduce the complications in the treatment interval and detect the residual lesions in time (43,44). In this study, we found that for the same type of bAVMs, the optimal intervention strategy proposed by different subspecialty departments often differ.…”

Section: Current Single-modality and Multi-modality Strategiesmentioning

confidence: 99%

Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

Chen¹,

Meng²,

Li³

et al. 2020

Preprint

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Background: In the benefit of the large population and rapid economic growth, the interventional techniques and equipment for brain arteriovenous malformations (bAVMs) in mainland China have been rapidly improved. Chinese neurosurgical cerebrovascular physicians have accumulated rich experience and made pioneering explorations. This study aims to summarize the experience and treatment progress of bAVMs in mainland China.Methods: We performed a web-based nationwide questionnaire survey among 67 tertiary neurosurgical institutions that had acknowledged treating bAVMs in the primary survey. Our questionnaire included clinical characteristics, radiological findings, intervention indications/contraindications, intervention timing, and intraoperative management of different treatment modalities. Results: A total of 63 participants from 49 (73.1%) tertiary neurosurgical institutions responded to our questionnaire. 42 (66.7%) were neurosurgeons, 13 (20.6%) were neurointerventionists, and 8 (12.7%) were radiosurgeons. Approximately 3500 to 4000 cases of bAVMs were treated annually in these 49 departments. All participants agreed that the conclusions of ARUBA are debatable. Flow-related aneurysms, deep venous drainage, and arteriovenous fistula were considered as common hemorrhagic risk factors. Unruptured SM IV-V bAVMs, giant bAVMs, pediatric bAVMs, elderly bAVMs, and eloquent bAVMs were not absolute contraindications to intervention. Maximum lesion occlusion and minimal functional impairment were the principles of intervention management. Most of the neurosurgeons and neurointerventionists recommended early intervention (<30 days) for ruptured bAVMs, and the radiosurgeons suggested intervention in the chronic phase or recovery phase (P<0.01), and preferably 3 months after bleeding. Multi-modality strategies were thought effective for complex bAVMs and more exploration of individualized intraoperative management was necessary.Conclusions: Intervention was acceptable for specific selected unruptured bAVMs in mainland China, especially in patients with hemorrhagic risk factors. The application of multidisciplinary cerebrovascular team and multicenter large-sample international registry study might be the next work for Chinese neurosurgical cerebrovascular physicians.Trial registration: ClinicalTrials.gov NCT04136860.

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Combined Endovascular and Microsurgical Treatment of Arteriovenous Malformations in the Hybrid Operating Room

Cited by 41 publications

References 23 publications

Quality improvement of nursing on patients with complex cerebral arteriovenous malformation undergoing hybrid surgery: a prospective single-center study

Quality improvement of nursing on patients with complex cerebral arteriovenous malformation undergoing hybrid surgery: a prospective single-center study

Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

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