显微手术治疗2月龄婴儿颅内巨大动脉瘤1例并文献复习  

Microsurgery of infantile intracranial aneurysm in a 2-month-old child with a literature review

作　　者：吴水华[1] 陈朝晖[1] 范双石 邹欣[1] 沈沉浮[2] Wu Shuihua;Chen Zhaohui;Fan Shuangshi;Zou Xin;Shen Chenfu(Department of Neurosurgery,Hunan Children's Hospital,Changsha 410007,China;Department of Neurosurgery,Affiliated Xiangya Hospital,Central South University,Changsha 410007,China)

机构地区：[1]湖南省儿童医院神经外科,湖南省长沙市410007 [2]中南大学湘雅医院神经外科,湖南省长沙市410007

出　　处：《临床小儿外科杂志》2020年第6期523-527,共5页Journal of Clinical Pediatric Surgery

基　　金：湖南省出生缺陷防治科技重大专项(编号:2019SK1010);湖南省卫生健康委员会一般项目(编号:B2017118)。

摘　　要：目的分析婴幼儿颅内动脉瘤(infantile intracranial aneurysm,IAM)的临床特征、诊治策略、病理特点和预后情况。方法回顾性分析在湖南省儿童医院行开颅显微手术治疗的1例2月龄颅内动脉瘤患儿临床资料,并通过检索PubMed、SpringerLink、Google Scholar、中国生物医学文献数据库(CBM)、中国知网、万方和维普数据库中关于婴幼儿颅内动脉瘤的相关文献进行复习。结果本例患儿,女,2月龄,行开颅探查颅内动脉瘤夹闭切除术,患儿相继于术后6个月、12个月再次来院随访复查,随访发现患儿发育良好,无明显临床症状,精神营养好,智力同正常同龄儿。先后两次复查头颅MRI+MRA,未见明显异常。通过检索文献数据库,联合本中心1例患儿,共有7例IAM患儿纳入本次研究。其中男女比为1∶6,平均年龄为4.29个月。6例以癫痫症状为首要临床表现,1例以嗜睡为首要临床表现。6例动脉瘤位于大脑中动脉,1例位于颈内动脉。5例影像学表现为脑实质出现异常,1例为硬膜下出血,1例为蛛网膜下腔出血。6例FISHER分级为Ⅳ级,1例为Ⅱ级。7例动脉瘤瘤体大小平均为0.99 cm,其中本院病例动脉瘤瘤体最大为1.5 cm。7例手术治疗患儿中,6例(6/7,85.7%)行开颅显微镜下动脉瘤夹闭术,1例(1/7,14.3%)行开颅显微镜下动脉瘤切除术。7例术后均确诊为颅内动脉瘤。3例预后正常,4例出现部分肢体活动功能障碍。结论婴幼儿动脉瘤十分罕见,起病机理有别于成人,目前治疗以开颅显微手术治疗为主,预后优于成人。Objective To explore the clinical characteristics,diagnostic and therapeutic strategies,pathological characteristics and prognosis of infantile intracranial aneurysm(IIA).Methods Retrospective analysis was performed for clinical data of a 2-month-old IIA child.And the relevant literature reports were retrieved from the databases of PubMed,SpringerLink,Google Scholar,CBM,CNKI,WANFANG and CQVIP.Results In this study,a 2-month-old child underwent transcranial exploration and clipping resection of intracranial aneurysms.Two follow-ups were conducted at 6 and 12 months.With decent nutrition and development,the girl had no obvious clinical symptoms.Her intelligence was the same as normal children of the same age.No obvious abnormality was detected by MRI+MRA.One related literature was retrieved.A total of 7 children were included.The ratio of boy to girl was 1:6 and the average age 4.29 months.The initial clinical manifestation was epilepsy(n=6)and drowsiness(n=1).The location of aneurysm was middle cerebral artery(n=6)and internal carotid artery(n=1).The imaging manifestations were cerebral parenchymal hemorrhage(n=5),subdural hemorrhage(n=1)and subarachnoid hemorrhage(n=1).Fisher s grade wasⅡ(n=1)andⅣ(n=6).The average size of aneurysms was 0.99 cm and the largest 1.5 cm.The procedure was microscopic clipping craniotomy(n=6,85.7%)and microscopic resection(n=1,14.3%).The prognosis was normal(n=3)and partial limb dysfunction(n=4).Conclusion IIA is quite rare.And its mechanism of disease onset is different from that of adults.Currently the major treatment is microsurgical craniotomy and its prognosis is better than that of adults.

关 键 词：颅内动脉瘤/外科学 显微外科手术 婴儿 

分 类 号：R616.2[医药卫生—外科学] R651.12[医药卫生—临床医学]