Preliminary observation of hybrid operation for intracranial unruptured arteriovenous malformations in children with epilepsy as the first symptom
Objective To investigate the efficacy of hybrid operation for intracranial unruptured arteriovenous malformations(AVM)with epilepsy as the first symptom in children.Methods A retrospective analysis was conducted on the clinical data of 14 children with intracranial unruptured AVM with epilepsy as the first symptom who were admitted to the Neurosurgery Department of Children's Hospital Affiliated to Nanjing Medical University from January 2018 to September 2022.There were 11 cases of normal and 3 cases of abnormal electroencephalogram(EEG)during the interictal phase.AVM was located in the frontal lobe in 7 cases,temporal lobe in 5 cases,and parietal and occipital lobes in 1 case each,all of which were dense.All 14 children were treated with hybrid surgery[cerebral digital subtraction angiography(DSA)and craniotomy surgery to remove AVM].For 3 cases with abnormal EEG,cortical EEG monitoring was performed during surgery,and radiofrequency thermocoagulation or resection of the epileptic focus was performed.The surgical complications were documented.DSA was performed 6 to 12 months after surgery,and annual imaging follow-up was performed.The neurological function was evaluated using the modified Rankin scale score(mRS),and the score of 0-1 in mRS was considered normal.The effectiveness of seizure control was evaluated using Engel grading system.Results All 14 cases underwent complete resection of the AVM.Among the 11 cases with normal preoperative EEG,2 cases were found to have deposition of hemosiderin and glial hyperplasia adjacent to AVM during surgery,and were removed;Among the 3 cases of preoperative abnormal EEG,2 cases were treated with effective thermocoagulation,and 1 case was treated with lesion cortical resection due to ineffective thermocoagulation.One patient developed hemiplegia and aphasia after surgery,and returned to normal two weeks later.Fourteen patients were followed up for 12-48 months(median:28 months).As of the last follow-up,there was no recurrence of AVM,and the neurological function of all 14 patients was normal.There were 13 cases with Engel grade Ⅰ a and 1 case with grade Ⅱ.Conclusion Preliminary observations have shown that using hybrid surgery to treat unruptured intracranial AVM in children with epilepsy as the initial symptom has a high cure rate and good safety.
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