儿童颅内动脉瘤血管内治疗  

Endovascular treatment for pediatric intracranial aneurysms

作　　者：李德洋[1] 石义亭[1] 吕宪利[2] 姜除寒[2] 

机构地区：[1]滕州中心人民医院神经外科,山东滕州277500 [2]北京市神经外科研究所

出　　处：《中华神经外科杂志》2009年第7期636-639,共4页Chinese Journal of Neurosurgery

摘　　要：目的报道儿童颅内动脉瘤血管内治疗的特征和血管内治疗的结果。方法2002—2006年收治29例儿童动脉瘤患者（年龄〈19岁）；其中14例蛛网膜下腔出血，10例意外发现，2例脑神经麻痹，3例神经功能障碍。动脉瘤的位置：10个椎动脉动脉瘤，5个大脑中动脉瘤，4个大脑后动脉瘤，3个基底动脉动脉瘤，3个前交通动脉瘤，1个小脑后下动脉瘤，2个大脑前动脉瘤，1个颈内动脉动脉瘤。结果7例动脉瘤行动脉瘤囊内弹簧圈栓塞，17例载瘤动脉闭塞（9例使用球囊闭塞载瘤动脉，8例使用弹簧圈载瘤动脉闭塞）。1例椎动脉瘤病人全脑血管造影后4d动脉瘤自发血栓形成。4例行支架或者支架辅助弹簧圈栓塞动脉瘤（其中2例基底动脉瘤患者死亡，2例动脉瘤栓塞后复发并再次给予栓塞治疗）。平均随访20．7个月，93．1％的病人GOS评分4分或5分。结论儿童颅内动脉瘤在发病特点上，男性比女性多见，好发部位是椎动脉、大脑后动脉和大脑中动脉。对于梭形动脉瘤行载瘤动脉闭塞是一种安全有效的治疗方法。基底动脉主干的梭形动脉瘤治疗困难而且死亡率高。Objective To study the characteristics and therapeutic outcomes of pediatric intraeranial aneurysms. Method From 2002 to 2006, 29 pediatric patients （age 〈 19 years ） with intracranial aneurysm were treated in our institute. Fourteen of 29 patients had SAH. In 10 patients, the aneurysm was an incidental finding. Two patients presented with cranial nerves dysfunction and 3 with neurological deficits. The location of aneurysms were as follows： vertebral artery（ n = 5 ）, posterior cerebral artery（ n = 4）, basilar artery （ n = 3 ） , anterior communicating artery（ n = 3 ）, posterior inferior cerebellar artery （ n = 1 ）, anterior cerebral artery （ n = 2 ） , internal carotid artery （ n = 1 ）. Results Seven patients were treated with selective embolization with coils. Seventeen patients were treated with parent vessel ocelusion（POV）. Nine POV were performed with balloons and 8 were performed 4 days after the initial diagnostic angiography. In 4 patients treated with sent or sent assisted coiling, 2 with BA trunk aneurysms deceased. The second treatment was used for two recurrence patients. At a mean follow - up duration of 20.7 months, 93.1% of patients had GOS score of 4 or 5. Conclusions Pediatric intracranial aneurysms occur more commonly in male patients and in VA, PCA, and MCA. POV is an effective and safe treatment for fusiform aneurysms. The treatment of basilar trunk fusiform aneurysms is difficult and is associated with high mortality rate.

关 键 词：儿童 颅内动脉瘤 血管内治疗 

分 类 号：R686[医药卫生—骨科学]