儿童颅内动静脉畸形出血的临床特点及治疗分析

doi:10.6040/j.issn.1671-7554.0.2014.082

摘要/Abstract

摘要： 目的探讨儿童颅内动静脉畸形(AVM)破裂出血的临床特点及治疗方式.方法对2010～2013年收治的28例儿童AVM出血患者(<18岁)的临床资料进行回顾性分析.结果 22例行显微手术、血管栓塞或综合治疗的病例根据Glasgow outcome scale(GOS)预后评分预后良好20例,中度残疾2例,无死亡.其中8例出血合并脑疝行急诊手术,6例预后良好,2例中度残疾.10例急性期行血管内栓塞、显微手术切除或综合治疗者复查DSA示畸形团不再显影,预后良好.2例单纯血管内栓塞治疗者及2例血管内栓塞结合伽马刀放射治疗者动静脉畸形复发,行再次栓塞治疗.6例因治疗困难,出血急性期行保守治疗后进一步行伽马刀放射治疗,随访至今未再出血.结论 AVM是儿童自发性颅内出血的主要原因,尽可能早期行DSA明确AVM情况,积极行介入栓塞、显微手术等是治疗儿童AVM的有效方法.

关键词: 动静脉畸形, 外科手术, 儿童, 出血

Abstract: Objective To investigate the clinical characteristics and treatment of rupture and hemorrhage of brain arteriovernous malformation (AVM) in children. Methods Clinical data of 28 children with cerebral AVM treated in our hospital during 2010 to 2013 were retrospectively reviewed. Results Of 22 patients who underwent interventional embolization or microsurgery or both, 20 were cured, and 2 were moderately disabled. Of the 8 cases receiving emergency operation due to hemorrhage complicated with cerebral hernia, 6 had fine prognosis and 2 were moderately disabled. Of the 10 cases treated with interventional embolization, microsurgery or both, DSA check-ups indicated the malformation was no longer developing. Two cases treated only with intravascular embolization and two cases treated with intravascular embolization combined with gamma knife had recurrence and underwent embolization treatment a second time. Of the 6 cases treated with conservative approach, no recurrent hemorrhage occurred. Conclusion Cerebral AVM is the primary cause of intracerebral spontaneous hemorrhage in children. DSA check-ups should be performed as early as possible to clarify the condition. Interventional embolization and microsurgery are effective treatments for pediatric AVM.

Key words: Children, Intracranial arteriovernous malformations, Hemorrhage, Microsurgery

中图分类号:

R651.1

张杰, 王志刚, 王益华, 姜彬, 何伟, 殷鑫, 郭文强. 儿童颅内动静脉畸形出血的临床特点及治疗分析[J]. 山东大学学报（医学版）, 2015, 53(2): 56-60.

ZHANG Jie, WANG Zhigang, WANG Yihua, JIANG Bin, HE Wei, YIN Xin, GUO Wenqiang. Clinical characteristics and treatment of intracranial arteriovenous malformation in children with acute hemorrhage[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(2): 56-60.

参考文献

[1] Hernesniemi JA, Dashti R, Juvela S, et al. Natural history of brain arteriovenous malformations: a long-term follow-up study of risk of hemorrhage in 238 patients[J]. Neurosurgery, 2008, 63(5):823-829.
[2] Fullerton HJ, Achrol AS, Johnston SC, et al. Long-term hemorrhage risk in children versus adults with brain arteriovenous malformations[J]. Stroke, 2005, 36(10):2099-2104.
[3] Skjøth-Rasmussen J, Obbekjær T, Birkeland P, et al. Multimodality treatment approach in children with cerebral arteriovenous malformation—a survey in the Danish population[J]. Childs Nerv Syst, 2012, 28(4):587-592.
[4] Bristo1 RE, Albuquerque FC, Spetzler RF, et al. Surgical management of arteriovenous malformations in children[J]. J Neurosurgery, 2006, 105(2 Suppl):88-93.
[5] 王忠诚. 神经外科学[M]. 武汉: 湖北科学技术出版社, 1998:632-658.
[6] Papadias A, Taha A, Sgouros S, et al. Incidence of vascular malformations in spontaneous intra-cerebral haemorrhage in children[J]. Childs Nerv Syst, 2007, 23(8):881-886.
[7] Niazi TN, Klimo P Jr, Anderson RC, et al. Diagnosis and Management of Arteriovenous Malformations in Children[J]. Neurosurg Clin N Am, 2010, 21(3):443-456.
[8] Sanchez-Mejia RO, Chennupati SK, Gupta N, et al. Superior outcomes in children compared with adults microsurgical resection of brain arteriovenous malformation[J]. J Neurosurg, 2006, 105(2):82-87.
[9] 王永和, 张振兴, 王培武, 等. 脑动静脉畸形破裂并血肿形成的急诊手术治疗[J]. 中华神经外科杂志, 2002, 18:400-402.
[10] Jayaraman MV, Marcellus ML, Do HM, et al. Hemorrhage rate in patients with Spetzler-Martin grades IV and V arteriovenous malformations: is treatment justified?[J]. Stroke, 2007, 8(2):325-329.
[11] Heros RC. Treatment of arteriovenous malformations: gamma knife surgery[J]. J Neurosurg, 2002, 97(4):754-755.
[12] Buis DR, Dirven CM, Lagerwaard FJ, et al. Radiosurgery of brain arteriovenous malformations in children[J]. J Neurol, 2008, 255(4):551-560.
[13] Lecavalier-Barsoum M, Roy D, Doucet R, et al. Long-term results of radiosurgery for cerebral arteriovenous malformations[J]. Can J Neurol Sci, 2013, 40(2):182-186.
[14] Dorfer C, Czech T, Bavinzski G, et al. Multimodality treatment of cerebral AVMs in children: a single-centre 20 years experience[J]. Childs Nerv Syst, 2010, 26(5):681-687.
[15] 于加省, 李龄. 儿童期癫痫手术治疗[J]. 立体定向和功能性神经外科杂志, 2002, 15(1):50-53.
[16] Weber W, Kis B, Siekmann R, et al. Preoperative embolization of intracranial arteriovenous malfornations with Onyx[J]. Neurosurgery, 2007, 61(2):244-252.
[17] Sakkas N, Schramm A, Metzger MC, et al. Arteriovcnous malformation of the mandible:a life-threatening situation[J]. Ann Hematol, 2007, 86(6):409-413.
[18] Kiris T, Sencer A, Sahinbas M, et al. Surgical results in pediatric Spetzler_Martin grades Ⅰ-Ⅲ intracranial arteriovenous malformations[J]. Childs Nerv Syst, 2005, 21:69-74.

相关文章 15

[1]	刘惠君,吴兆婷,王玉立,徐明阳,刘霄,康燕,王红梅. 子宫下段收缩不良导致的产后出血的危险因素及早期干预[J]. 山东大学学报 (医学版), 2026, 64(5): 61-66.
[2]	李东梅,边天帅,王晓华,张静,赵炎,孙素芬,牟鸿,许安廷. 儿童前庭神经炎的前庭诱发肌源性电位结果[J]. 山东大学学报 (医学版), 2026, 64(4): 38-43.
[3]	孙红林,管玉强,于培儒,李磊,杜庆霞,丁浩. 支架植入治疗儿童主动脉缩窄并高血压的可行性及近中期疗效[J]. 山东大学学报 (医学版), 2026, 64(4): 58-62.
[4]	况利,徐何雁. 从精准评估到整合干预:儿童青少年心理健康问题诊疗范式的革新与展望[J]. 山东大学学报 (医学版), 2026, 64(3): 10-16.
[5]	李芳华,刘娜,李晓宇,许殿花,王倩. 儿童青少年抑郁障碍患者服药依从性研究进展[J]. 山东大学学报 (医学版), 2026, 64(3): 24-34.
[6]	孙佳丽,王亮,王长凤,张杰,郭磊. Klippel-Trenaunay综合征儿童情绪与行为特征及其影响因素[J]. 山东大学学报 (医学版), 2026, 64(3): 78-82.
[7]	王倩,胡晓婧,王爱青,孙强,孟春燕,李芳华. 儿童青少年抑郁障碍患者非自杀性自伤文献的可视化分析[J]. 山东大学学报 (医学版), 2026, 64(3): 93-107.
[8]	王悦祺,宋东玉,李玉丽,谢昊,张月蓉. 儿童困难问题和亲社会行为在家庭弹性与祖辈隔代教养压力间的中介作用[J]. 山东大学学报 (医学版), 2026, 64(1): 57-64.
[9]	张政,王建伟,杨玉娟,张宇,宋西成. 哮喘儿童2008及2019年免疫球蛋白E变化及相关危险因素[J]. 山东大学学报 (医学版), 2025, 63(7): 32-36.
[10]	曹洛菲,王珊珊,王金荣,姜荷云,苗瑜,马光增. 哮喘发作期FeNO升高儿童肺功能舒张试验的特点分析[J]. 山东大学学报 (医学版), 2025, 63(6): 38-44.
[11]	陈绪军, 何国伟. 着力进一步推进动脉桥在我国冠心病冠脉旁路移植术中的应用[J]. 山东大学学报 (医学版), 2025, 63(5): 1-5.
[12]	莫绪明,王庆峰. 冠状动脉旁路移植术在儿童心血管疾病中的应用[J]. 山东大学学报 (医学版), 2025, 63(5): 40-46.
[13]	李玲,闫宇晗,孔清玉,王敏敏,赵海招,赵翠芬. 直立不耐受症状评分及儿茶酚胺与血管迷走性晕厥患儿情绪障碍的相关性[J]. 山东大学学报 (医学版), 2025, 63(5): 71-78.
[14]	王梦园,张春艳,于文文,寇琳娜,王世富. 2018—2021年山东省儿童与成人临床分离真菌的构成与主要菌种的体外抗真菌药物敏感性监测[J]. 山东大学学报 (医学版), 2025, 63(4): 83-93.
[15]	龚蓉,崔乃雪,陈恺悦,赵佳,单瑞洁,张训琪. 体感游戏在儿童癌症幸存者中的应用[J]. 山东大学学报 (医学版), 2025, 63(4): 94-99.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed