One-stop hybrid operation versus microsurgery for treating brain arteriovenous malformation in children--A retrospective case series

Abstract Background Brain arteriovenous malformation (AVM) is one of the most common causes of cerebral hemorrhage in children. The effectiveness of one-stop hybrid operation in the treatment of AVMs in adults has been widely confirmed, but there are few studies in children. This study intends to analyze the role and significance of one-stop hybrid operation versus microsurgery in the treatment of AVMs in children by retrospective analysis. Methods A total of 57 children (≤ 18 years old) with AVMs who were admitted to the 900th Hospital of United Logistics Support Forces and Fujian Children's Hospital between September 2018 and August 2022 were retrospectively analyzed. According to the inclusive criteria and exclusion criteria, 38 cases were included, and they were divided into microsurgery group (25 cases) and hybrid operation group (13 cases) according to the different treatment modalities. Observation indicators included clinical characteristics: gender, age, initial symptom, presence or absence of signs, GCS score, Hunt-Hess grade; imaging characteristics such as the location of AVMs, Spetzler-Martin (S-M) grade, whether accompanied by intraventricular hemorrhage, treatment and prognosis indicators such as intraoperative blood loss, operation time, imaging cure, postoperative complications, hospital stay, and 3 months and 6 months mRS after operation. Results The proportion of female patients (P = 0.042), the proportion of patients whose AVMs was located on the supratentorial (P = 0.034) and the proportion of patients whose S-M grade was above grade III (P = 0.003) in the hybrid operation group were higher than those of the microsurgery group. The intraoperative blood loss (P < 0.001), operation time (P < 0.001) and postoperative hospital stay (P = 0.024) of patients in the microsurgery group were higher than those in the hybrid operation group. The presence of signs and S-M grade may be relevant factors in predicting the surgical approach, and the probability of selecting hybrid operation for each step of increasing S-M grade is 3.046 times that of microsurgery. Conclusions One-stop hybrid operation is effective and safe for the treatment of brain AVMs in children. High S-M grade of AVMs is more suitable for hybrid operation.