Effect of intravascular embolization combined with surgical resection in the treatment of scalp arteriovenous malformations

doi:10.3877/cma.j.issn.2095-9141.2024.05.003

Abstract

Abstract:

Objective

To investigate the effect of intravascular embolization combined with surgical resection in the treatment of scalp arteriovenous malformations （SAVMs）.

Methods

The clinical data of 53 patients with SAVMs admitted to Neurosurgery Department of the 970^th Hospital of the Joint Logistics Support Force of the People’s Liberation Army of China from January 2011 to February 2021 were retrospectively analyzed， and the patients were divided into surgical resection group （n=21）and joint therapy group （n=32） according to the different surgical approaches. The surgical resection group applied surgical resection treatment， and the joint therapy group applied intravascular embolization combined with surgical resection treatment. The clinical symptom improvement， imaging findings，postoperative complications and recurrence rate were observed and compared between two groups.

Results

There was no statistically significant difference in the total resection rate between the two groups （P＞0.05）. The blood loss and operation time in joint therapy group were both less than those in surgical resection group，and the differences were statistically significant （P＜0.05）.The clinical symptoms（scalp swelling， localized pressure sensation and dizziness） and imaging evaluation results （maximum diameter of SAVMs， vascular diameter and blood flow resistance index） showed improvement in both groups after treatment， and the improvement was more significant in joint therapy group compared to surgical resection group （P＜0.05）. The incidence rate of neurological damage and postoperative bleeding in joint therapy group was lower than that in surgical resection group （P＜0.05）. Within 2 years of postoperative follow - up， the recurrence rate in surgical resection group was 19.05%， whereas no recurrence occurred in joint therapy group， the difference was statistically significant （P＜0.05）.

Conclusion

Application of intravascular embolization combined with surgical resection in the treatment of SAVMs can effectively ameliorate the clinical symptoms， reduce the size of lesion， improve the peripheral vascular status，and lower the recurrence rate.

Key words: Scalp arteriovenous malformations, Intravascular embolization, Surgical resection, Joint therapy

Huating Liu, Yuan Zhang, Dengwen Zhang, Jie Wang, Yang Yuan. Effect of intravascular embolization combined with surgical resection in the treatment of scalp arteriovenous malformations[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2024, 10(05): 273-278.

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Figures/Tables 5

Tab.1 Comparison of general information between two groups

项目	介入联合组（n=32）	手术切除组（n=21）	t/χ²值	P值
性别（男/女）	19/13	13/8	0.034	0.854
年龄（岁， $\overset{ˉ}{x}$ ±s）	32.46±10.89	34.67±6.71	0.831	0.410
病程（年， $\overset{ˉ}{x}$ ±s）	3.16±0.58	2.95±0.62	1.255	0.215
病变部位（额部/颞部/额顶/枕部）	8/11/7/6	5/7/6/3	0.392	0.942
瘤体最大直径（cm， $\overset{ˉ}{x}$ ±s）	8.27±2.13	7.25±2.37	1.631	0.109
供血动脉（单支血管/多支供血动脉）	13/19	14/7	3.441	0.064
供血动脉血流速度（cm/s， $\overset{ˉ}{x}$ ±s）	35.12±6.53	32.41±5.73	1.549	0.127

Tab.1 Comparison of general information between two groups

项目	介入联合组（n=32）	手术切除组（n=21）	t/χ²值	P值
性别（男/女）	19/13	13/8	0.034	0.854
年龄（岁， $\overset{ˉ}{x}$ ±s）	32.46±10.89	34.67±6.71	0.831	0.410
病程（年， $\overset{ˉ}{x}$ ±s）	3.16±0.58	2.95±0.62	1.255	0.215
病变部位（额部/颞部/额顶/枕部）	8/11/7/6	5/7/6/3	0.392	0.942
瘤体最大直径（cm， $\overset{ˉ}{x}$ ±s）	8.27±2.13	7.25±2.37	1.631	0.109
供血动脉（单支血管/多支供血动脉）	13/19	14/7	3.441	0.064
供血动脉血流速度（cm/s， $\overset{ˉ}{x}$ ±s）	35.12±6.53	32.41±5.73	1.549	0.127

Tab.2 Comparison of surgical related indicators between two groups

组别	例数	全切率[例（%）]	出血量（mL， $\overset{ˉ}{x}$ ±s）	手术时间（h， $\overset{ˉ}{x}$ ±s）
介入联合组	32	27（84.38）	87.29±11.46	1.63±0.57
手术切除组	21	16（76.19）	236.87±31.28	2.34±0.49
t/χ²值		0.555	24.739	4.861
P值		0.456	＜0.001	＜0.001

Tab.2 Comparison of surgical related indicators between two groups

组别	例数	全切率[例（%）]	出血量（mL， $\overset{ˉ}{x}$ ±s）	手术时间（h， $\overset{ˉ}{x}$ ±s）
介入联合组	32	27（84.38）	87.29±11.46	1.63±0.57
手术切除组	21	16（76.19）	236.87±31.28	2.34±0.49
t/χ²值		0.555	24.739	4.861
P值		0.456	＜0.001	＜0.001

Tab.3 Comparison of clinical symptoms between two groups［n（%）］

组别	例数	头皮肿胀				局部压迫感				头晕
组别	例数	治疗前	治疗后	χ²值	P值	治疗前	治疗后	χ²值	P值	治疗前	治疗后	χ²值	P值
介入联合组	32	23（71.88）	1（3.13）	32.267	＜0.001	19（59.38）	2（6.25）	20.483	＜0.001	29（90.63）	1（3.13）	49.192	＜0.001
手术切除组	21	17（80.95）	6（28.57）	11.629	0.001	16（76.19）	7（33.33）	7.785	0.005	20（95.24）	5（23.81）	22.235	＜0.001
χ²值		0.564	5.144			1.599	4.816			0.008	5.144
P值		0.453	0.024			0.206	0.028			0.928	0.024

Tab.4 Comparison of imaging evaluation results between two groups（Mean±SD）

组别	例数	SAVMs最大直径（cm）				血管内径（mm）				RI
组别	例数	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
介入联合组	32	8.27±2.13	0.94±0.31	19.264	＜0.001	2.53±0.21	1.85±0.21	12.952	＜0.001	0.53±0.03	0.79±0.06	21.925	＜0.001
手术切除组	21	8.58±2.37	1.56±0.72	12.988	＜0.001	2.56±0.22	2.03±0.23	7.631	＜0.001	0.54±0.04	0.71±0.03	15.581	＜0.001
t值		0.496	4.315			0.499	2.939			0.711	5.894
P值		0.662	＜0.001			0.619	0.005			0.480	＜0.001

Tab.5 Comparison of postoperative complications between two groups［n（%）］

组别	例数	瘢痕形成	感染	神经功能损伤	术后出血
介入联合组	32	2（6.25）	1（3.13）	0（0.00）	2（6.25）
手术切除组	21	3（14.29）	4（19.05）	5（23.81）	8（38.10）
χ²值		0.249	2.130	5.857	6.448
P值		0.618	0.144	0.016	0.011

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