Hybrid treatment of central nervous system arteriovenous fistulas: A single center experience

Authors : Çağrı Elbir, Göktuğ Ülkü
Pages : 370-379
Doi:10.29058/mjwbs.1790682
View : 26 | Download : 33
Publication Date : 2025-12-31
Article Type : Research Paper
Abstract :Aim: Central nervous system arteriovenous fistulas (AVFs) are abnormal connections between arteries and veins that pose a significant neurological risk. This study evaluated the clinical and angiographic outcomes of patients who underwent endovascular (EVT), surgical (ST), or hybrid (surgery after endovascular treatment) treatment for cerebral AVFs. Material and Methods: A retrospective analysis was conducted on 22 patients treated at our hospital between January 2023 and January 2024. The collected data included demographics, Glasgow Coma Scale score, feeding artery, fistula classification, treatment modality, angiographic and neurological outcomes, and mortality. Treatment decisions were individualized based on fistula characteristics and patient condition. Statistical analyses were performed using SPSS v25.0. Results: Twenty-two patients (mean age 52.4, 68.2% male) underwent EVT (n=12), ST (n=5), or hybrid (n=5) treatment. Complete fistula occlusion was achieved in 11 patients (50%), with no significant difference among treatment groups (EVT 36.4%, ST 36.4%, hybrid 27.3%, p=0.29). Overall mortality was 18.2% (EVT 3 (25%), ST 1 (2%), p=0.77). Neurological outcomes showed that 31.8% developed new postoperative deficits, 31.8% had unchanged neurological deficits and 36.4% experienced complete neurological recovery. Notably, no neurological deterioration was observed in the hybrid treatment group. Patients who received hybrid treatment exhibited a significantly higher complete recovery rate (p=0.004). Hybrid treatment may be associated with less neurological deterioration and greater improvement. Conclusion: Endovascular, surgical, and hybrid approaches showed comparable effectiveness in treating AVFs in terms of occlusion rates, neurological deficits, and mortality. In addition, hybrid treatment has significant advantages, including a high complete recovery rate and low neurological deterioration rate. Larger multicenter prospective studies are warranted to further refine the treatment protocols.
Keywords : Arteryovenöz fistüller, santral sinir sistemi, hibrit tedavi, endovasküler tedavi, mikrocerrahi

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