Application of hybrid operation in the treatment of spinal cord vascular malformation:a preli-minary report
Objective To preliminarily explore the application and efficacy of hybrid surgery in the treatment of spinal cord vascular malformations.Methods A retrospective analysis was performed on the clinical data of 26 patients with spinal cord vascular malformations who underwent hybrid surgery[digital subtraction angiography(DSA)combined with microsurgery]at the Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,from November 2019 to June 2023,including 11 cases of spinal dural arteriovenous fistulas(SDAVF),11 cases of peri-medullary arteriovenous fistula(PMAVF)and 4 cases of spinal arteriovenous malformation(SAVM).Neuroelectrophysiological monitoring was performed on patients with PMAVF and SAVM during surgery.The patients were followed up through outpatient or hospitalization,and spinal cord DSA examination was reviewed;the modified Aminoff-Logue disability score was used to evaluate spinal cord function(a score decrease of ≥ 1 was considered improvement).Results All 26 patients had their lesions resected according to the preoperative plan.No significant decrease in amplitude was found in the intraoperative neuroelectrophysiological monitoring of 15 patients.Eleven cases of SDAVF and 10 cases of PMAVF all had a single fistula.The DSA results immediately after surgery showed that the lesion was not visualized and normal blood vessels in the spinal cord were preserved.In one case of PMAVF with multiple fistulas,only one lesion causing symptoms was removed according to the preoperative plan and immediate postoperative DSA showed that the lesion was not visualized.In 4 patients with SAVM,the lesions were completely removed,and the immediate postoperative DSA results showed that the malformed vascular mass was not visualized.On the 2nd day after surgery,the sensory impairment of 25 patients was improved compared with that before surgery,but the movement and sphincter function did not improve significantly.In another patient,sphincter dysfunction worsened after surgery.None of the patients had postoperative complications such as bleeding and infection.The postoperative follow-up time[M(Q1,Q3)]of 26 patients was 21(8,35)months.By the last follow-up,the spinal cord function of all 26 patients had improved,with the modified Aminoff-Logue disability score decreasing by 1 point in 6 cases,by 2 points in 11 cases,and by 3 points in 9 cases.No recurrence of spinal vascular malformation at the surgical site was found in the DSA review.Conclusion Preliminary observations show that in patients with spinal cord vascular malformations,including SDAVF,PMAVF and SAVM,hybrid surgery can be performed to accurately resect the lesions with good safety and no short-term recurrence.
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