Clinical outcomes of procedures combining endovascular embolization with a direct surgical approach in a hybrid operating room for the treatment of refractory dural arteriovenous fistulas.
Angiography
Arteriovenous fistula
Hybrid operating room
Robotic C-arm
Journal
Surgical neurology international
ISSN: 2229-5097
Titre abrégé: Surg Neurol Int
Pays: United States
ID NLM: 101535836
Informations de publication
Date de publication:
2021
2021
Historique:
received:
17
05
2021
accepted:
15
07
2021
entrez:
13
9
2021
pubmed:
14
9
2021
medline:
14
9
2021
Statut:
epublish
Résumé
We reviewed the clinical outcomes of a procedure that combines endovascular embolization and a direct surgical approach in a hybrid operating room (OR) for the treatment of refractory dural arteriovenous fistulas (dAVFs). All patients with intracranial dAVFs who underwent a procedure combining endovascular embolization and direct surgical approach with biplane angiography or a robotic C-arm system in a hybrid OR between February 2004 and June 2020 were considered. Borden grading, occlusion rate, pre-and post-operative modified Rankin Scale (mRS) scores, and complications were retrospectively investigated. The pre-and postoperative mRS scores were compared using the Wilcoxon signed-ranks test. We evaluated 14 arteriovenous fistulas (AVFs) in consecutive 13 patients. Of these, ten AVFs were previously treated with endovascular embolization, ten were located in the transverse-sigmoid sinus, and four in the cortical vein. The Borden grade was II in two AVFs and III in 12 AVFs. Immediate occlusion of the AVF was achieved in 13 AVFs, and gradual occlusion was observed in one case. The median preoperative mRS was 1 (0-3), whereas the median postoperative mRS was 0 (0-1) which indicated marked improvement ( The combination of endovascular embolization and direct surgical approach in a hybrid OR could achieve sufficient occlusion of refractory AVFs with acceptable complication rates and improved symptoms.
Sections du résumé
BACKGROUND
BACKGROUND
We reviewed the clinical outcomes of a procedure that combines endovascular embolization and a direct surgical approach in a hybrid operating room (OR) for the treatment of refractory dural arteriovenous fistulas (dAVFs).
METHODS
METHODS
All patients with intracranial dAVFs who underwent a procedure combining endovascular embolization and direct surgical approach with biplane angiography or a robotic C-arm system in a hybrid OR between February 2004 and June 2020 were considered. Borden grading, occlusion rate, pre-and post-operative modified Rankin Scale (mRS) scores, and complications were retrospectively investigated. The pre-and postoperative mRS scores were compared using the Wilcoxon signed-ranks test.
RESULTS
RESULTS
We evaluated 14 arteriovenous fistulas (AVFs) in consecutive 13 patients. Of these, ten AVFs were previously treated with endovascular embolization, ten were located in the transverse-sigmoid sinus, and four in the cortical vein. The Borden grade was II in two AVFs and III in 12 AVFs. Immediate occlusion of the AVF was achieved in 13 AVFs, and gradual occlusion was observed in one case. The median preoperative mRS was 1 (0-3), whereas the median postoperative mRS was 0 (0-1) which indicated marked improvement (
CONCLUSION
CONCLUSIONS
The combination of endovascular embolization and direct surgical approach in a hybrid OR could achieve sufficient occlusion of refractory AVFs with acceptable complication rates and improved symptoms.
Identifiants
pubmed: 34513202
doi: 10.25259/SNI_486_2021
pii: 10.25259/SNI_486_2021
pmc: PMC8422465
doi:
Types de publication
Journal Article
Langues
eng
Pagination
439Informations de copyright
Copyright: © 2021 Surgical Neurology International.
Déclaration de conflit d'intérêts
This study was partially supported by a research grant (ID C00221026) from Siemens Healthcare K.K. Katharina Otani is an employee of Siemens Healthcare K.K.
Références
World Neurosurg. 2018 Dec;120:e932-e939
pubmed: 30189315
J Thorac Dis. 2020 Apr;12(4):1342-1349
pubmed: 32395271
J Stroke Cerebrovasc Dis. 2012 Nov;21(8):918.e1-5
pubmed: 22721822
Neurosurg Rev. 2021 Feb;44(1):435-450
pubmed: 31897884
Neurosurgery. 2011 May;68(5):1427-32; discussion 1433
pubmed: 21273937
Cerebrovasc Dis Extra. 2020;10(2):84-93
pubmed: 32846415
Acad Radiol. 2020 Jun;27(6):e123-e131
pubmed: 31445824
World Neurosurg. 2018 Sep;117:e204-e214
pubmed: 29890278
J Neurosurg. 2006 Jun;104(6):925-30
pubmed: 16776336
J Neurosurg. 2015 Apr;122(4):933-8
pubmed: 25526277
J Clin Neurosci. 2002 May;9 Suppl 1:11-5
pubmed: 23570148
Int J Health Policy Manag. 2020 Jul 27;:
pubmed: 32729284
J Neurosurg. 1998 Mar;88(3):449-56
pubmed: 9488298
J Clin Neurosci. 2020 Jun;76:87-99
pubmed: 32284290
J Neurointerv Surg. 2015 Feb;7(2):e6
pubmed: 24489124
World Neurosurg. 2019 Feb;122:e186-e197
pubmed: 30292668
AJNR Am J Neuroradiol. 2011 Jun-Jul;32(6):1091-5
pubmed: 21622580
J Neurosurg. 2017 Jun;126(6):1884-1893
pubmed: 27588586
J Neurointerv Surg. 2013 Sep 1;5(5):489-93
pubmed: 22661589
J Neurosurg. 2019 Jun 28;:1-8
pubmed: 31252394