Hybrid surgical resection for ruptured intracranial arteriovenous malformation in the acute stage: A report from a single center

Objective: To investigate the advantages of intracranial arteriovenous malformation (AVM) treatment in a hybrid operating room (OR) Design: Retrospective analyses of prospectively recorded data Setting: Department of Neurosurgery, The First Hospital of Jilin University, Jilin Province, China Subject: We continuously collected the data of 15 AVM patients treated with surgical resection assisted by intraoperative digital subtraction angiography (DSA). Intervention: The AVM treatments were divided into two categories: in Type I, intraoperative DSA was mainly used to embolize difficult-to-expose feeding arteries and part of the AVM to reduce intraoperative bleeding. In Type II, intraoperative DSA was mainly used to simplify determination of the AVM position and check for residuals after surgical removal. Main outcome measure: The Hunt-Hess (HH) scale was used to determine the preoperative patient status. The prognosis was evaluated with the Glasgow Outcome Scale (GOS). Results: The distribution of patients according to the HH scale was as follows: grade I in one case, grade II in 11 cases and grade III in three cases. In seven patients with Type I AVM, the AVM was completely removed after embolization. In eight patients with Type II AVM, DSA confirmed complete removal of the AVM. Ten patients had a GOS score of 5 points, and five patients had a score of 4 points. Conclusions: DSAis the most promising method to surgically remove an AVM in a hybrid OR. AVMs can reasonably be classified as Type I and Type II for further treatment.