儿童软脑膜动静脉瘘的血管内治疗(附3例报道及文献复习)  

Endovascular treatment of pediatric pial arteriovenous fistulas:report of three cases and review of literature

作　　者：潘力[1] 刘鹏[1] 秦杰[1] 陈剑[1] 冯雷[2] 刘军[2] 杨铭[1] 马廉亭[1] 

机构地区：[1]中国人民解放军武汉总医院神经外科 [2]济宁市第一人民医院神经外科,山东272011

出　　处：《中国临床神经外科杂志》2017年第4期209-212,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨儿童软脑膜动静脉瘘(PAVFs)的临床特点、诊断及血管内栓塞治疗的技术方法、安全性及疗效。方法回顾性分析2013年7月至2015年7月血管内栓塞治疗的3例儿童PAVFs的临床资料。结果 3例均为单一瘘口,瘘口静脉端形成3~6 cm大小的静脉瘤。2例行瘘口及静脉瘤弹簧圈与18%ONYX胶栓塞,1例因静脉瘤太大通过双微导管技术仅行近瘘口供血动脉弹簧圈及18%ONYX胶栓塞。栓塞后即刻造影示3例瘘口均消失。术后症状缓解,无动脉栓塞、出血、神经功能缺失等并发症。经CTA或DSA随访6个月~2年均无复发。结论单一瘘口的儿童PAVFs治愈率高,预后好。三维融合影像(3D-DSA双血管融合,CT/MRI及3D-DSA影像融合)有助于术前更好了解病变的血管解剖特点并制定手术方案;血管内栓塞治疗是理想的治疗方法,复发率低,但其有效性还需长期随访。Objective To investigate the clinical characteristics, and diagnosis and treatment of pediatric pial arteriovenous fistulas （PAVFs）. Methods The clinical data of 3 pediatric patients with PAVFs undergoing endovascular embolization from July, 2013 to July, 2015 were analyzed retrospectively. Results Of 3 patients with single orifieium fistula associated with giant venous variees （3-6 cm）, 2 underwent successful embolization of the fistulas and venous varices with coils and 18% ONYX, and 1 only embolization of the feeding artery and fistula by double microcatheters technique. DSA immediately after the embolization showed that the orificium fistulas completely disappeared ia 3 patients. All the patients were followed up from 6 to 24 months. No complications including neurological deficits and so on occurred and no fistula recurred in 3 patients during the following-up. Conclusions The curative effects of endovascular embolization on the pediatric PAVFs are good. Three-dimensional fusion images are helpful to understanding of the characteristics and making of operative plan of the PAVFs in children.

关 键 词：软脑膜动静脉瘘 儿童 血管内治疗 疗效 

分 类 号：R743.4[医药卫生—神经病学与精神病学] R815.2[医药卫生—临床医学]