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Updated: Jul 4, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Pediatric Brain AVM: The Role of DSA During Surgery in Hybrid Operating Room
1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Insights
Pediatric brain arteriovenous malformations (BAVM) are severe, but surgical resection offers high cure rates. Hybrid operating rooms enhance BAVM resection by enabling intraoperative imaging and reducing recurrence.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Pediatric Neurology
Background:
- Pediatric brain arteriovenous malformations (BAVM) present a higher risk of hemorrhage and a more severe natural course compared to adult cases.
- Surgical resection is the most effective treatment for BAVM, particularly when the Spetzler-Martin grade is ≤6, and is emphasized for ruptured or younger pediatric patients.
Purpose of the Study:
- To evaluate the efficacy and outcomes of surgical resection for pediatric brain arteriovenous malformations (BAVM) utilizing a hybrid operating room.
- To assess the role of intraoperative digital subtraction angiography (DSA) in ensuring complete resection and minimizing recurrence in pediatric BAVM cases.
Main Methods:
- A retrospective analysis of 123 pediatric BAVM cases undergoing surgical resection in a hybrid operating room between 2015 and 2024.
- Simultaneous open surgery and interventional procedures were performed, with intraoperative DSA used to assess resection completeness and DSA for postoperative follow-up.
Main Results:
- Complete resection was achieved in the majority of cases, with residual BAVM detected on initial intraoperative DSA in 8% (10 cases).
- The recurrence rate confirmed by DSA was 6.5% (8 cases) over the study period.
- Hybrid operating rooms facilitated comprehensive management, including emergency decompression for large hematomas.
Conclusions:
- Surgical resection in a hybrid operating room is a safe and effective strategy for pediatric brain arteriovenous malformations, offering high cure rates and enabling precise assessment of resection.
- The use of intraoperative DSA in a hybrid setting is crucial for confirming complete resection and reducing the likelihood of recurrence in complex pediatric BAVM cases.
- Individualized treatment strategies remain essential for managing pediatric BAVM due to its challenging nature.
Abstract:
Brain arteriovenous malformations (BAVM) are congenital vascular malformations in which abnormal communication is formed between arteries and veins. Pediatric BAVM was more prone to hemorrhage than adult BAVM. And the natural course of pediatric BAVM was more severe than that of adult BAVM.Among the three main treatment options, surgical resection offers the highest cure rate. Surgical resection was prioritized when the total score of the supplementary Spetzler-Martin grade was ≤6. This approach was especially emphasized for children with ruptured AVMs and for younger patients who were not suitable candidates for stereotactic radiotherapy. However, for unruptured BAVMs located near functional areas, stereotactic radiotherapy could be considered the preferred treatment option.A hybrid operating room allows the simultaneous performance of open surgery and interventional procedures. The primary benefit of a hybrid operating room is the ability to determine residual BAVM through intraoperative DSA, ensuring complete resection. Furthermore, for BAVMs with higher Spetzler-Martin grades, those located in eloquent areas, with complex structures or diffuse types, or those that have previously undergone surgery, these cases are particularly well-suited for procedures performed in a hybrid operating room. For patients with large hematomas requiring emergency decompression, emergency surgery in a hybrid operating room is a more reasonable option. In such a setting, preoperative DSA, surgical resection, and postoperative DSA can be performed within the same session.From 2015 to 2024, a total of 123 cases of surgical resection of BAVM in children were performed at this center using a hybrid operating room. Residual BAVM was identified during the first intraoperative DSA in 10 cases (8%). There were 8 cases (6.5%) of confirmed recurrence by DSA.BAVM remains the most challenging disease for neurosurgeons. Individualized treatment strategy needs to be formulated for each pediatric patient.