Preliminary experience of hybrid operation in the treatment of cerebral and spinal vascular diseases

Objective To investigate the clinical effect of hybrid operation in the treatment of cerebral and spinal vascular diseases. Methods A retrospective analysis was made on the clinical data of 15 patients with cerebral and spinal vascular diseases who were admitted to Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University from January 2017 to June 2018. Of the 15 patients, emergency surgery was performed in 7 patients and elective surgery in 8 patients. Five cases of intracranial aneurysms were treated with surgical clipping, in which 4 of them needed clip adjustment during operation, 1 case underwent temporary balloon-assisted parent artery occlusion and 1 case underwent salvage superficial temporal artery (STA)-middle cerebral artery (MCA) low flow bypass; 5 cases of intracranial arteriovenous malformations were treated with partial embolization combined with surgical resection; and the 4 cases of dural arteriovenous fistula and 1 case of intracranial arteriovenous fistula were treated with fistula clamping. The patients' outcomes were assessed based on Glasgow Outcome Scale (GOS). Results All hybrid operations were successfully performed. The 5 cases of aneurysms were clipped with no residual neck, and the anastomotic vessel in the patient undergoing STA-MCA salvage bypass was patent. Among the 5 cases of intracranial arteriovenous malformations, 3 cases were resected totally, and 2 cases were found to have residual malformation mass by intraoperative angiography and the operation was continued to achieve complete resection in the end. Only 1 case of residual fistula was detected by intraoperative angiography of the 4 cases of dural arteriovenous fistula and 1 case of cerebral arteriovenous fistula. By adjusting the clip, the fistula was closed completely. The GOS grade of the 15 patients at discharge were: grade Ⅴ in 8 cases, grade Ⅳ in 5 and grade Ⅲ in 2. The patients were followed up for 3 to 18 months. The mean follow-up time was 10.2±3.5 months and their conditions were stable, including 9 cases with GOS grade Ⅴ, 4 cases with GOS grade Ⅳ and 2 cases with GOS grade Ⅲ. Conclusions Hybrid surgery is a new mode of surgical treatment for cerebral and spinal vascular diseases, which could improve the accuracy and effect of operation, effectively reduce the incidence of complications, and seems safe and reliable in our initial application. Key words: Intracranial aneurysm; Intracranial arteriovenous malformations; Arteriovenous fistula; Spinal cord vascular diseases; Hybrid operation