儿童烟雾病合并颅内动脉瘤的临床特点和预后  

Clinical features and outcomes of comorbid Moyamoya disease and intracranial aneurysm in children

作　　者：刘鹏[1] 尤为 杨日淼 吕明[1] 李佑祥[1] 段炼 Liu Peng;You Wei;Yang Rimiao;Lyu Ming;Li Youxiang;Duan Lian(Beijing Neurosurgical Institute,Department of Interventional Neuroradiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,the Fifth Medical Center of PLA General,Beijing 100071,China)

机构地区：[1]北京市神经外科研究所,首都医科大学附属北京天坛医院神经介入中心,100070 [2]解放军总医院第五医学中心神经外科,北京100071

出　　处：《中华神经外科杂志》2020年第12期1195-1199,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81901197)。

摘　　要：目的探讨儿童烟雾病合并颅内动脉瘤的临床特点和预后。方法纳入首都医科大学附属北京天坛医院神经介入中心(2例)和解放军总医院第五医学中心神经外科(9例)于2002年10月至2017年10月收治的儿童烟雾病合并颅内动脉瘤的患者,共11例(11个动脉瘤)。回顾性分析其临床特点和随访预后。结果11例患儿中,男/女=8/3,年龄为5~16岁(中位数为9岁)。首发症状为短暂性脑缺血发作(TIA)2例,脑梗死1例,脑出血8例。11个动脉瘤中,主要动脉型3个,外周动脉型8个;均为囊性。3例外周动脉型动脉瘤患儿行Onyx胶栓塞治疗,2例成功,1例失败;8例患儿动脉瘤未予处理。10例患儿接受了双侧脑-硬膜-颞浅动脉血管融通术(EDAS),1例因双侧脑膜中动脉代偿良好,未行EDAS。术后影像学随访6~36个月(中位数为12个月)。10例患儿双侧颞浅动脉均向颅内代偿供血,其中侧支循环生长Matsushima分级1级者8例,2级者2例;10例行EDAS者中,4例外周动脉型动脉瘤自行消失,2例主要动脉型动脉瘤增大,1例外周动脉型、1例主要动脉型动脉瘤无变化,2例行栓塞者动脉瘤均无复发;1例未行EDAS者动脉瘤无变化。临床随访3~14年(中位数为10年)。8例出血患儿随访期间无再出血;3例缺血患儿中,术后1例发生过2次TIA,2例无脑缺血症状。结论烟雾病合并动脉瘤患儿中,合并外周动脉型动脉瘤者多于主要动脉型动脉瘤;均为囊性。EDAS可有效改善患儿的脑血流,促进外周动脉型动脉瘤闭塞,并可预防发生再出血。Objective To investigate the the clinical characteristics and prognosis of pediatric comorbid Moyamoya disease(MMD)and intracranial aneurysm.Methods Between October 2002 and October 2017,11 pediatric MMD patients with intracranial aneurysms were treated at Department of Interventional Neuroradiology,Beijing Tiantan Hospital,Capital Medical University(two cases)and the Fifth Medial Center of PLA General Hospital(nine cases)and enrolled into this study.We retrospectively analyzed the patients′clinical features and followed up their outcomes.Results Among 11 patients in our series,8 were male and 3 were female,with a median age of 9 years(5-16 years).Initial manifestations included transient ischemic attack(TIA)in two patients,cerebral infarction in one and intracranial hemorrhage in eight patients.Among all 11 aneurysms,three were located at the main artery and 8 at the peripheral artery.Onyx embolization was performed in three children with peripheral artery aneurysms,out of whom success was achieved in two and failures were reported in one.The other eight patients underwent no surgical treatment.Ten children underwent the operation of encephalo-duro-arterio-synangiosis(EDAS),and one did not undergo EDAS due to good collateral circulation of bilateral meningeal arteries.Postoperative imaging follow-up lasted for 6-36 months with a median of 12 months.Intracranial blood supply by collateral circulation of superficial temporal artery was observed in 10 patients.Among them,the evaluation of transdural collaterals after EDAS revealed Matsushima grade 1 in eight patients and grade 2 in two.Among ten patients undergoing EDAS,peripheral artery aneurysms regressed spontaneously in four,main artery aneurysms were enlarged in two,main artery remained stable in one,and peripheral artery aneurysm remained stable in one.Two cases with peripheral artery aneurysms reported no recurrence after onyx embolization.The main artery aneurysm remained stable in one patient without undergoing EDAS surgery.Clinical follow-up lasted for

关 键 词：颅内动脉瘤 外周动脉 北京天坛医院 儿童烟雾病 颞浅动脉 脑缺血症状 侧支循环 脑膜中动脉 

分 类 号：R743[医药卫生—神经病学与精神病学]