Comparison Of Microsurgery And Compound Surgery In The Treatment Of Hemorrhagic Cerebral Arteriovenous Malformation

Objective:Through retrospective clinical case analysis,we explored the difference of prognosis between simple microsurgery and compound surgery(interventional embolization + microsurgery)among patients with hemorrhagic cerebral arteriovenous malformations.Method:1 Data sources and the set of standard: all data from this study were obtained from Department of Neurosurgery,East Hospital of Second Hospital of Hebei Medical University since April 2014~ February 2017.The set of standard of: the patients according to the medical history,imaging or lumbar puncture confirmed cerebral hemorrhage,subarachnoid hemorrhage,intraventricular hemorrhage,subdural hemorrhage;second after admission all by MRA or / and CTA or / and DSA and confirmed by surgery for cerebral arteriovenous malformation;who meet the above criteria can diagnosis of hemorrhagic cerebral arteriovenous malformation,a total of 41 cases were included in this study.2 Cases: the study is divided into compound surgery group and microsurgery group,(4)the compound surgery group(15 cases): Interventional embolization of cerebral arteriovenous malformations(c AVM)under general anesthesia firstly,embolization of all feeding arteries or some of the main feeding arteries,then microsurgical resection was performed.(5)Microsurgery group(26 cases): Microsurgical removal of cAVM under general anesthesia.3 Comparison of contents and statistical methods: two groups of patients with gender,age,vascular malformation,the diameter of the feeding arteries and draining veins,concomitant aneurysm,cAVM location,Spetzler-Martin classification,Tiantan classification,Shi yuquan classification,preoperativeNIHSS score,postoperative NIHSS score,bleeding volume,the amount of blood transfusion,operative time,postoperative mRS score and postoperative GOS score were summarized,the application of SPSS13.0 software for statistical analysis.Results:Compound surgery and simple microsurgery group in the site of cAVM(x~2=0.655,P=0.418),whether accompanied with aneurysms(x~2=0.307,P=0.580),the main artery(x~2=4.178,P=0.372)Spetzler-Martin classification(x~2=3.876,P=0.409),Tiantan classification(x~2=3.219,P=0.224);Shi yuquan classification(x~2=4.912,P=0.080)has not significant difference.There was comparability between the two groups.There were no significant differences in bleeding volume(Z=-1.297,P=0.195),the amount of blood transfusion(Z=-1.630,P=0.103)and operative time(Z=-0.989,P=0.323)between the compound surgery group and simple microsurgery group.There was no significant difference in postoperative GOS score(x~2=0.687,P=0.373)and postoperative mRS score(x~2=3.593,P=0.664)between the compound surgery group and simple microsurgery group.Conclusion:1 There was no significant difference in bleeding volume,the amount of blood transfusion and operative time between the compound surgery group and simple microsurgery group.2 Compound surgery has no difference in the prognosis of patients.This case is a single center retrospective study with relatively small number of cases,and there may be a case bias.The conclusion should be confirmed by multicenter and prospective randomized case-control study.