gms | German Medical Science

Objective: To demonstrate our decision-making process, selection and surgical technique of patients with complex cerebral and spinal vascular malformations suitable for interdisciplinary treatment in a hybrid-angio-surgical-suite.

Method: We analysed the treatment procedures of highly selected neurovascular lesions during an observation period between 2008 and 2010 using repetitive biplane intraoperative digital subtraction angiography in the hybrid-suite, the clinical and radiological results, as well as the feasibility of the procedure in relation to standard procedures.

Results: Patients were selected by an interdisciplinary team, if the risk for residual lesion was considered as high. Diffuse and multiple neurovascular lesions as well as ventrally located spinal lesions proved to be suitable. Among 451 patients with neurovascular lesions (321 patients with 492 intracranial aneurysms (IA), 88 arterio-venous malformations (AVMs) and 42 dural arterio-venous fistulas (dAVF)), only six (~1%) underwent treatment in the hybrid-suite. Three presented with arteriovenous malformations (cerebral n=2, spinal n=1) and three with dural arteriovenous fistulas (cerebral n=2, spinal n=1). Complete elimination of the neurovascular lesion was achieved in all cases selected for hybrid-treatment without additional neurological deficits. None of the patients selected for a standard procedure required additional hybrid-treatment for a residual lesion.

Conclusions: Combined interdisciplinary one-stage treatment in the hybrid suite proved to be helpful and effective for both, clinical and radiological outcome. Careful selection for patients, who are at an increased risk for incomplete elimination is mandatory. However, in the vast majority standard neurointerventional and neurosurgical procedures are sufficient.