Single-Stage Combined Embolization and Resection for Spetzler-Martin Grade III/IV/V Arteriovenous Malformations: A Single-Center Experience and Literature Review.
Single-Stage Combined Embolization and Resection for Spetzler-Martin Grade III/IV/V Arteriovenous Malformations: A Single-Center Experience and Literature Review.
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Spetzler-Martin III/IV/V级动静脉畸形的单期联合栓塞切除术：单中心经验与文献综述
DOI：
10.3389/fneur.2020.570198
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发表时间：
2020
影响因子：
3.4
通讯作者：
Zhao Y
中科院分区：
文献类型：
--
作者：
Chen Y;Li R;Ma L;Zhao Y;Yu T;Wang H;Ye X;Wang R;Chen X;Zhao Y
背景和目的：本研究旨在确定Spetzler-Martin（SM）III/IV/V级动静脉畸形（AVM）的一期联合栓塞和显微手术策略的有效性和术中操作细节。研究方法：作者回顾性审查了2016年1月至2018年2月期间接受混合手术和单纯手术切除术的连续SM III/IV/V级AVM。在破裂或未破裂亚组中，比较混合组和单纯手术切除组的结局[改良兰金量表（mRS）]。与长期残疾相关的因素进行了评估，使用多变量逻辑回归分析。结果：共评估了100例AVM患者（47例使用混合手术矫正，53例仅通过手术切除矫正）。经过平均2.3 ± 0.6年的随访，我们发现这两种策略之间的长期预后和残疾率没有差异。然而，混合策略在加速切除过程方面具有显著优势[破裂（P = 0.000）;未破裂（P = 0.002）]。在危险因素分析中，过度栓塞（C级，60-100%）与混合队列中的长期残疾显著相关（P = 0.041;比值比24.000; 95% CI，1.140-505.194），在单纯手术切除队列中，深穿动脉受累是长期残疾的重要预测因素（P = 0.025;比值比，15.389; 95%CI，1.412-167.66）。在混合队列的亚组分析中，推荐中度栓塞（B级，30-60%），因为术中大出血的风险比较低（P = 0.033）。结论：一期联合栓塞和切除术是治疗SM III/IV/V级AVM的有效策略。虽然长期结果与单纯手术切除相似，但混合策略具有明显的缩短切除时间的优势。在混合技术中，建议适度栓塞，过度栓塞可能不利于随后的显微手术切除。临床试验注册：http://www.clinicaltrials.gov。唯一标识符：NCT 04136860。
Background and Purpose: This study sought to identify the efficacy and intraoperative operational details of single-stage combined embolization and microsurgery strategy for Spetzler-Martin (SM) grade III/IV/V arteriovenous malformations (AVMs). Methods: The authors retrospectively reviewed consecutive SM grade III/IV/V AVMs who underwent hybrid procedures and surgical resection alone procedures from January 2016 to February 2018. Outcomes [modified Rankin Scale (mRS)] were compared between hybrid group and surgical resection alone group in ruptured or unruptured subgroup. Factors associated with long-term disability were assessed using multivariable logistic regression analyses. Results: A total of 100 AVM patients (47 corrected using hybrid procedures whereas 53 by surgical resection alone) were evaluated. After a mean follow-up of 2.3 ± 0.6 years, we found no difference in long-term prognosis and incidences of disability rates between these two strategies. However, the hybrid strategy offers significant advantage in accelerating the resection process [ruptured (P = 0.000); unruptured (P = 0.002)]. In the analysis of risk factors, excessive embolization (Grade C, 60–100%) was significantly associated with long-term disability in the hybrid cohorts (P = 0.041; odds ratio, 24.000; 95% CI, 1.140–505.194), and involvement of deep perforating arteries was the significant predictor of long-term disability in the surgical resection alone cohort (P = 0.025; odds ratio, 15.389; 95% CI, 1.412–167.66). In the subgroup analysis of the hybrid cohort, moderate embolization (Grade B, 30–60%) was recommended because of the low risk ratio of major intraoperative bleeding (P = 0.033). Conclusions: Single-stage combined embolization and resection is an efficient strategy for the treatment of SM grade III/IV/V AVMs. Although the long-term outcomes were similar to surgical resection alone, the hybrid strategy had obvious advantages of shorter resection. In the hybrid technique, moderate embolization was recommended, and excessive embolization might be detrimental to the subsequent microsurgical resection. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT04136860.
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影响因子：
4.8
作者：
Ivanov, Alexander A.;Alaraj, Ali;Amin-Hanjani, Sepideh
通讯作者：
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影响因子：
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