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One-staged in situ embolization combined with surgical resection for eloquence protection of AVM: technical note

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Abstract

Brain arteriovenous malformations (AVMs) near/within eloquent areas are challenging to treat surgically. The insufficient lesion-to-eloquence distance (LED) is related to poor neurological outcomes. This paper reports the use of in situ embolization combined with surgical resection in a one-staged hybrid operation for eloquent area protection. Nine patients who underwent one-staged in situ embolization combined with surgical resection were selected from the database of a prospective clinical trial (NCT03774017). Nidus got partial in situ embolization in the parts located near/within the eloquence. The rest of nidus was removed via a microsurgical procedure in the same operation. The in situ embolization ensured a sufficient LED to prevent eloquent areas and tracts from being damaged in the subsequent resection. All of the patients achieved complete obliteration with no neurological deficits or complications. One-staged hybrid operation initiates closer cooperation between surgical and endovascular treatments and proposes an integrative therapeutic mode for AVMs. The in situ embolization combined with surgical resection is safe and effective for improving the functional outcome of AVMs with eloquence and tracts involved. The clinical trial is registered at ClinicalTrials.gov (NCT03774017, https://clinicaltrials.gov/ct2/show/NCT03774017).

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Acknowledgments

H. Li and M. Zhao provided critical advice on our work. This report relied on the careful perioperative management of neurosurgeons and nurses at our institute.

Funding

This study was supported by Beijing Science and Planning Project (No. D161100003816005) and Key Technologies Research and Development Program (No. 2016YFC1301800).

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 Southern 4th Ring Road West, Fengtai District, Beijing, 100070, China

    Mingze Wang, Hancheng Qiu, Yong Cao, Shuo Wang & Jizong Zhao

  2. China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China

    Mingze Wang, Hancheng Qiu, Yong Cao, Shuo Wang & Jizong Zhao

  3. Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100050, China

    Mingze Wang, Hancheng Qiu, Yong Cao, Shuo Wang & Jizong Zhao

  4. Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, 100070, China

    Mingze Wang, Hancheng Qiu, Yong Cao, Shuo Wang & Jizong Zhao

Authors
  1. Mingze Wang
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  2. Hancheng Qiu
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  3. Yong Cao
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  4. Shuo Wang
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  5. Jizong Zhao
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Contributions

Conception and design: Zhao, S. Wang, and Y. Cao. Analysis and interpretation of the data: M. Wang. Drafted the article: M. Wang. Critically revised the article: Qiu and Y. Cao. Reviewed the submitted version of the manuscript: H. Qiu, Y. Cao, S. Wang, and J. Zhao. Approved the final version of the manuscript on behalf of all of the authors: M. Wang, H. Qiu, Y. Cao, S. Wang, and J. Zhao.

Corresponding author

Correspondence to Jizong Zhao.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The study was approved by the Institutional Review Board of Beijing Tiantan Hospital (approval number KY2016-034-02).

Informed consent

Written informed consent was obtained from the participants before recruitment, including their permission for the anonymous publication of their information and images in this study and other academic uses. For the participant under the age of 18 years or with limited capacity for civil conduct, written consent was obtained from at least one of their legal guardians.

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Wang, M., Qiu, H., Cao, Y. et al. One-staged in situ embolization combined with surgical resection for eloquence protection of AVM: technical note. Neurosurg Rev 42, 783–790 (2019). https://doi.org/10.1007/s10143-019-01137-w

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  • DOI: https://doi.org/10.1007/s10143-019-01137-w

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