title: [Combined surgical and endovascular treatments of complex cerebral arteriovenous malformation in hybrid operating room].
abstract: OBJECTIVE
  To summarize the clinical experiences of microsurgical and endovascular treatments of complicated arteriovenous malformation (AVM) in the conditions of hybrid operating room.
  
  
  METHODS
  The clinical data were collected and analyzed for 8 patients of complex AVM between June 2012 to June 2013. There were Spetzler grade III (n = 2) and grade IV (n = 6). And the lesions were complicated with intracranial aneurysms (n = 3) and located in motor area (n = 2) and basal ganglia (n = 2). Five cases of AVM with cerebral hemorrhage underwent emergency surgery, including digital subtraction angiography (DSA) plus intraoperative embolization plus surgical resection of AVM plus intraoperative DSA (iDSA). Two cases underwent embolization plus aneurysm surgery while another had AVM embolization plus AVM resection and γ knife treatment.
  
  
  RESULTS
  All surgical procedures, including iDSA, were completed in the same hybrid operating room. There was no change of surgical position or intraoperative mortality. Five patients of AVM hemorrhage undergoing emergency hematoma evacuation had no residue of AVM on iDSA. Their postoperative consciousness improved without neurological dysfunction. Two patients of limb paralysis recovered to paresis at 3 months postoperation. One case with blurry vision improved somewhat. Two cases undergoing elective surgery had a complete resection of AVM after embolization.
  
  
  CONCLUSIONS
  Surgery plus endovascular treatment in hybrid operating room is efficacious for complex cerebral AVM. It avoids multiple surgeries and inspections. And any lesion residue may be assessed immediately with postoperative DSA.
authors.affiliation: First Quanzhou Affiliated Hospital, Fujian Medical University, Quanzhou 362000, China.
authors.forename: Jinjun
authors.initials: J
authors.lastname: Tian
authors.affiliation: First Quanzhou Affiliated Hospital, Fujian Medical University, Quanzhou 362000, China.
authors.forename: Zhizhong
authors.initials: Z
authors.lastname: Lin
authors.affiliation: First Quanzhou Affiliated Hospital, Fujian Medical University, Quanzhou 362000, China.
authors.forename: Jinning
authors.initials: J
authors.lastname: Zhang
authors.affiliation: First Quanzhou Affiliated Hospital, Fujian Medical University, Quanzhou 362000, China.
authors.forename: Qingdong
authors.initials: Q
authors.lastname: Yang
authors.affiliation: First Quanzhou Affiliated Hospital, Fujian Medical University, Quanzhou 362000, China.
authors.forename: Jincong
authors.initials: J
authors.lastname: Huang
authors.affiliation: First Quanzhou Affiliated Hospital, Fujian Medical University, Quanzhou 362000, China.
authors.forename: Han
authors.initials: H
authors.lastname: Zhang
authors.affiliation: First Quanzhou Affiliated Hospital, Fujian Medical University, Quanzhou 362000, China.
authors.forename: Mouyi
authors.initials: M
authors.lastname: Li
authors.affiliation: First Quanzhou Affiliated Hospital, Fujian Medical University, Quanzhou 362000, China.
authors.forename: Jianxing
authors.initials: J
authors.lastname: Huang
authors.affiliation: First Quanzhou Affiliated Hospital, Fujian Medical University, Quanzhou 362000, China. Email: zongxuyi@163.com.
authors.forename: Xuyi
authors.initials: X
authors.lastname: Zong
mesh_terms: D015901:Angiography, Digital Subtraction; D002543:Cerebral Hemorrhage; D004621:Embolization, Therapeutic; D006801:Humans; D002532:Intracranial Aneurysm; D002538:Intracranial Arteriovenous Malformations; D009873:Operating Rooms; D016634:Radiosurgery; D016896:Treatment Outcome; D014680:Veins