Surgical Management of Cerebral Arteriovenous Malformations Within Hybrid Operation Room

Purpose: Have an evaluation of clinical benefits and risks of hybrid operating techniques in management of cerebral arteriovenous malformations(AVMs). Meanwhile, as a new cooperative interventional modality, optimized workflows, technical key knots and operation routines will be explored in the study.

Objects: Patients with cerebral arteriovenous malformations, coincident with inclusion and exclusion criterion and admitted in participating organizations.

Methods: Patients will be distributed into 2 groups, including traditional therapy group(control group) and hybrid operating group(trial group), and conduct with traditional neurosurgical management or one-stage hybrid operating management correspondingly. Residual rate of AVM is considered to be the primary observing indicator, and morbidity rate of post-operative complications, post-operative mortality rate, and morbidity rate of neural functional deterioration are secondary indicators.The information of operations will be recorded in detail as evidence of optimization of workflow and technical key knots.

Inclusion criteria

• newly ruptured AVM with stable hematoma, selective operation is practical;
• with rupture history;
• recurrent epilepsy, failed in AED management;
• giant AVM with deterioration of neurological functions;
• 1-4 grade AVM (Spetzler-Martin grading system) with no symptom and not located in eloquent area.

Exclusion criteria

• >70 in age, with low rupture risk;
• newly ruptured AVM with unstable hematoma, engaged in emergency operation;
• ≥5 grade in Spetzler-Martin grading system;
• AVM located in hypothalamus, brainstem, cerebellopontine angle;
• cannot tolerant the operation;
• patient or relative refuses to participate the trail.