摘要
目的 探讨小儿脑血管畸形的影像学特征及血管内治疗的方法与效果。方法 回顾性研究近 9年我院收治的小儿脑血管畸形 6 5例 ,男 37例 ,女 2 8例。所有患儿均行选择性全脑血管造影明确诊断 ,并行血管内栓塞治疗。栓塞材料采用真丝线段 2 9例 ,NBCA胶栓塞 2 1例 ,真丝线段与NBCA胶联合栓塞 15例。结果 脑血管造影显示 :血管畸形位于基底节及中线部位为主者 2 8例 ,以皮层为主者 2 3例 ,后颅窝 14例。颈内动脉分支供血 7例 ,大脑前动脉分支供血者 38例 ,大脑中动脉分支供血 2 9例 ,大脑后动脉分支供血 19例 ,基底动脉分支供血 14例。病灶最大直径 5 .0cm× 5 .0cm× 6 .0cm。最小直径 2 .0cm× 3.0cm× 3.0cm。血管内治疗一次栓塞 4 3例 ,二次栓塞治疗 18例 ,4例巨大型病灶行三次栓塞。 2 4例解剖治愈 ,病灶闭塞 80 %～ 90 % 2 1例 ,闭塞 6 0 %～ 70 % 15例 ,闭塞5 0 %以下 5例。 38例随访 5个月至 9年 ,18例解剖治愈者无复发 ,残存病灶者中有 2例分别于术后2个月、3年再次出血 ,其中 1例死亡 ,1例偏瘫。 1例术后 3个月死于充血性心力衰竭。结论 血管内治疗对小儿脑血管畸形是有效的和安全的治疗方法。
Objective To characterize the radiological image and evaluate therapeutic approach to the treatment for cerebral vascular malformations in children.Methods Sixty five children (male 37, female 28) with cerebral vascular malformations diagnosed by selective cerebral angiography were hospitalized in the last 9 years. Endovascular embolization was carried out in all of the cases. Twenty nine patients underwent embolization only with silk thread, 21 with NBCA gel and 15 with both silk thread and NBCA gel. The clinical results were analyzed retrospectively.Results Angiography showed that of the 65 cases with arteriovenous malformations, 28 were in the basal ganglia or near the middle line, 23 in the cortex, 14 cases in the posterior fossa. Arteriovenous malformations were supplied by the internal carotid artery in 7 cases, by the anterior cerebral artery in 38 cases, by the middle cerebral artery in 29, by the posterior cerebral artery in 19 . The size of the focus ranged from 2.0 ?cm× 3.0 ?cm× 3.0 ?cm to 5.0 ?cm× 5.0 ?cm× 6.0 ?cm. Single emolization was performed on 43 cases, double embolizations on 18, and 3 embolizatons on 4 cases with huge cerebral vascular malformations. 100% obliteration was achieved in 24 cases, 80%～90% obliteration in 21, 60%～70% obliteration in 15, and <50% obliteration in 5 cases. The follow up of 38 cases with a period from 5 month to 9 years showed that 18 cases had no recurrence. Among the 20 patients with residual cerebral malformations, re bleeding was seen in 2 cases (one died 2 months later and another had hemiplegia 3 years postoperatively). One patient died of congestive heart failure 3 months after the surgery. Conclusion Endovascular treatment is a safe and effective therapeutic method for management of the cerebral vascular malformations in children.
出处
《中华小儿外科杂志》
CSCD
北大核心
2002年第3期211-213,共3页
Chinese Journal of Pediatric Surgery
