Surgical Management of Cerebral Arteriovenous Malformations Within Hybrid Operation Room (SMAVMHR)

To evaluate the clinical benefits and risks of hybrid operating techniques in management of cerebral arteriovenous malformations.

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.

Traditional therapy group：traditional management of AVMs, such as unsimultaneous endovascular interventional embolisation, radiotherapy followed by microsurgical resection, will be conducted to patients involved in this group. Hybrid operation group: A one-stage hybrid operation combining endovascular intervention and microsurgical techniques will be conducted simultaneously to patients in this group.

Unsimultaneous endovascular interventional embolisation/radiotherapy followed by microsurgical resection, as traditional clinical routines.

A one-stage hybrid operation combining endovascular intervention and microsurgical techniques will be conducted simultaneously

endovascular interventional embolisation, endovascular interventional balloon occlusion, microsurgical resection

A one-stage cooperation of existing endovascular interventional techniques and microsurgical techniques, including microsurgical resection, endovascular embolization, balloon occlusion.

Include intracranial hemorrhage or infarction, infection of central neural system, infection of respiratory system, cranial nerve deficits, and other symptomatic complications

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.