Objective Single-stage surgery combining embolisation and microsurgery has been increasingly used as a stand-alone procedure to cure complex AVMs.This study aimed to investigate the learning curve and embolisation str...Objective Single-stage surgery combining embolisation and microsurgery has been increasingly used as a stand-alone procedure to cure complex AVMs.This study aimed to investigate the learning curve and embolisation strategy for single-stage surgery for AVMs.Methods This prospective cohort study used data from the nationwide Multimodality Treatment for Brain Arteriovenous Malformations(MATCH)registry in China,conducted between August 2011 and December 2023.A total of 213 complex AVMs were divided into two groups.Group 1 included the first 25 patients.The 188 cases in group 2 included patients numbered 26-213.A case-crossover design was employed to evaluate the influence of complications,unfavourable outcomes and worsening modified Rankin Scale(mRS)score.Cumulative summation analysis was performed to assess the learning curve.Results The rate of major complications decreased from 52.00%in group 1 to 34.57%in group 2(p=0.089),while the rate of unfavourable outcomes decreased from 44.00%in group 1 to 18.62%in group 2(p=0.004).The distribution of the three preoperative embolisation strategies was as follows:curative:72.00%and 19.15%,palliative:24.00%and 67.55%,and targeted:4.00%and 13.30%,respectively(p<0.001).Multivariable regression analysis showed that surgeon experience was associated with a lower rate of unfavourable outcomes(p=0.022,OR=0.333).The mean follow-up duration was 49.90±20.54 months.The follow-up mRS score of 5-6 decreased from 9.09%in group 1 to 0.8%in group 2(p=0.035).Conclusions Performing single-stage combined surgery in 25 AVM cases is necessary to achieve reproducibility.Rates of major complications and unfavourable outcomes decreased significantly after the first 50 procedures.Palliative and targeted embolisation strategies are associated with a lower rate of unfavourable outcomes.展开更多
Background The extubation time is critical during the intensive care unit stay in aneurysmal subarachnoid hemorrhage(aSAH)patients.The current conventional parameters for predicting extubation failure(EF)and extubatio...Background The extubation time is critical during the intensive care unit stay in aneurysmal subarachnoid hemorrhage(aSAH)patients.The current conventional parameters for predicting extubation failure(EF)and extubation time may not be suitable for this population.Here,we aimed to identify factors associated with EF in aSAH patients.Methods From a single-center observational study on aSAH patients with computed tomography angiography from 2019 to 2021,patients who received microsurgery were enrolled and divided into two groups according to whether EF occurred.Multivariable logistic regression was conducted to evaluate disease severity,medical history,and extubation time differences between patients with and without EF.Results Of 335 patients included,EF occurred with a rate of 0.14.Delayed cerebral ischemia(67.4%vs.13.5%)and acute hydrocephalus(6.5%vs.1.4%)were frequently observed in patients with EF.Also,patients who develop EF presented higher disability(65.9%vs.17.4%)and mortality(10.9%vs.0.7%)rates.Multivariable analysis demonstrated that age(OR 1.038;95%CI 1.004-1.073;P=0.028),onset to admission time(OR 0.731;95%CI 0.566-0.943;p=0.016),WFNS grade>3(OR 4.309;95%CI 1.639-11.330;p=0.003),and extubation time<24 h(OR 0.097;95%CI 0.024-0.396;p=0.001)were significantly associated with EF occurrence.Conclusions These data provide further evidence that older aSAH patients with onset to admission time<2 days and WFNS grade>3 have a high risk of developing EF,which is amplified by the ultra-early extubation.Moreover,in patients with two or more risk factors,a prolonged intubation recommendation requires consideration to avoid the EF.展开更多
基金supported by the National Key Research and Development Program of China(Grant No.2021YFC2501101 and 2020YFC2004701 to XC)Natural Science Foundation of China(Grant no.82202244 to YC)Top Talent Support Program for Medical Experts Team of Wuxi Health Committee(Grant No.202109 to SW).
文摘Objective Single-stage surgery combining embolisation and microsurgery has been increasingly used as a stand-alone procedure to cure complex AVMs.This study aimed to investigate the learning curve and embolisation strategy for single-stage surgery for AVMs.Methods This prospective cohort study used data from the nationwide Multimodality Treatment for Brain Arteriovenous Malformations(MATCH)registry in China,conducted between August 2011 and December 2023.A total of 213 complex AVMs were divided into two groups.Group 1 included the first 25 patients.The 188 cases in group 2 included patients numbered 26-213.A case-crossover design was employed to evaluate the influence of complications,unfavourable outcomes and worsening modified Rankin Scale(mRS)score.Cumulative summation analysis was performed to assess the learning curve.Results The rate of major complications decreased from 52.00%in group 1 to 34.57%in group 2(p=0.089),while the rate of unfavourable outcomes decreased from 44.00%in group 1 to 18.62%in group 2(p=0.004).The distribution of the three preoperative embolisation strategies was as follows:curative:72.00%and 19.15%,palliative:24.00%and 67.55%,and targeted:4.00%and 13.30%,respectively(p<0.001).Multivariable regression analysis showed that surgeon experience was associated with a lower rate of unfavourable outcomes(p=0.022,OR=0.333).The mean follow-up duration was 49.90±20.54 months.The follow-up mRS score of 5-6 decreased from 9.09%in group 1 to 0.8%in group 2(p=0.035).Conclusions Performing single-stage combined surgery in 25 AVM cases is necessary to achieve reproducibility.Rates of major complications and unfavourable outcomes decreased significantly after the first 50 procedures.Palliative and targeted embolisation strategies are associated with a lower rate of unfavourable outcomes.
文摘Background The extubation time is critical during the intensive care unit stay in aneurysmal subarachnoid hemorrhage(aSAH)patients.The current conventional parameters for predicting extubation failure(EF)and extubation time may not be suitable for this population.Here,we aimed to identify factors associated with EF in aSAH patients.Methods From a single-center observational study on aSAH patients with computed tomography angiography from 2019 to 2021,patients who received microsurgery were enrolled and divided into two groups according to whether EF occurred.Multivariable logistic regression was conducted to evaluate disease severity,medical history,and extubation time differences between patients with and without EF.Results Of 335 patients included,EF occurred with a rate of 0.14.Delayed cerebral ischemia(67.4%vs.13.5%)and acute hydrocephalus(6.5%vs.1.4%)were frequently observed in patients with EF.Also,patients who develop EF presented higher disability(65.9%vs.17.4%)and mortality(10.9%vs.0.7%)rates.Multivariable analysis demonstrated that age(OR 1.038;95%CI 1.004-1.073;P=0.028),onset to admission time(OR 0.731;95%CI 0.566-0.943;p=0.016),WFNS grade>3(OR 4.309;95%CI 1.639-11.330;p=0.003),and extubation time<24 h(OR 0.097;95%CI 0.024-0.396;p=0.001)were significantly associated with EF occurrence.Conclusions These data provide further evidence that older aSAH patients with onset to admission time<2 days and WFNS grade>3 have a high risk of developing EF,which is amplified by the ultra-early extubation.Moreover,in patients with two or more risk factors,a prolonged intubation recommendation requires consideration to avoid the EF.
