血管内介入栓塞治疗婴幼儿软脑膜动静脉瘘的效果分析  

Efficacy of endovascular interventional embolization for pial arteriovenous fistula in infants

作　　者：李静伟[1] 支兴龙[1] 叶明[1] 李桂林[1] 曾高[1] 张鸿祺[1] Li Jingwei;Zhi Xinglong;Ye Ming;Li Guilin;Zeng Gao;Zhang Hongqi(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中国脑血管病杂志》2021年第7期465-471,共7页Chinese Journal of Cerebrovascular Diseases

基　　金：国家重点研发计划(2016YFC1301800);2020年度国自然青年培育项目(QNPY2020009)。

摘　　要：目的探讨血管内介入栓塞治疗婴幼儿软脑膜动静脉瘘(PAVF)的安全性和有效性。方法回顾性连续纳入2008年5月至2018年5月在首都医科大学宣武医院神经外科接受血管内介入治疗的婴幼儿(0~3岁)PAVF患儿。记录患儿的临床资料(病程、症状、体征、栓塞方式等)、影像学资料(MR、DSA检查,包括病变部位、汇入窦、闭塞静脉窦、狭窄静脉窦等)及随访情况(包括随访方式、随访时间及随访结果等)等,评价术中栓塞操作相关并发症(如破裂出血、栓塞材料移位等)、动静脉瘘闭塞程度(完全闭塞、部分残留)和围手术期手术相关并发症和随访(采用电话、门诊、住院方式)时临床症状改善情况[采用改良Rankin量表(mRS)评价,mRs评分≤2分为预后良好]。结果共纳入15例患儿,其中前循环病变8例,后循环病变7例。患儿术中采用弹簧圈联合Onyx或Glubran栓塞5例,球囊微导管辅助Glubran栓塞5例,Glubran栓塞3例,单纯弹簧圈栓塞2例。术后即刻造影显示病变完全闭塞14例,无围手术期手术相关并发症发生。长期随访35~156个月结果显示,PAVF病变完全闭塞12例,复发2例,部分残留1例,继发硬脑膜动静脉瘘3例,mRS评分0分13例,1分2例。结论血管内介入栓塞治疗婴幼儿PAVF具有较高的安全性和有效性,但应注意防治病变的部分残留和继发性硬脑膜动静脉瘘。Objective To investigate the safety and effectiveness of endovascular interventional embolization in the treatment of pial arteriovenous fistula(PAVF)in infants.Methods The infants(0-3 years old)with PAVF who received endovascular interventional treatment in the Department of Neurosurgery,Xuanwu Hospital of Capital Medical University from May 2008 to May 2018 were retrospectively enrolled.Clinical data(course of disease,symptoms,signs,embolization method,etc.),imaging data(MR,DSA,including lesion site,confluence sinus,occluded venous sinus,stenosed venous sinus,etc.)and follow-up information(follow-up method,follow-up time,follow-up results,etc.)were recorded.Complications related to intraoperative embolization(rupture and hemorrhage,embolization material displacement,etc.),degree of arteriovenous fistula occlusion(complete embolization,partial resdue),perioperative operation-related complications and clinical symptom improvement during follow-up(modified Rankin scale[mRS]by telephone,outpatient,or hospitalization;mRS score≤2 as good prognosis)were evaluated.Results A total of 15 patients were included,including 8 cases of anterior circulation lesion and 7 cases of posterior circulation lesion.Among these patients,6 were treated with coils combined with Onyx/Glubran,5 with Glubran assisted by balloon microcatheter,3 with Glubran alone and 2 with coils alone.Immediate postoperative angiography showed complete occlusion in 14 cases,and no perioperative complications occurred.Long-term follow-up of 35-156 months showed that complete embolization in 12 cases,recurrence in 2 cases,partial residue in 1 case,and secondary dural arteriovenous fistula(DAVF)in 3 cases.The mRS score was 0 in 13 cases and 1 in 2 cases.Conclusion Intravascular embolization is safe and effective in the treatment of PAVF in infants,but attention should be paid to the prevention and treatment of lesion recurrence or secondary DAVF.

关 键 词：动静脉瘘 介入栓塞 婴幼儿 软脑膜动静脉瘘 继发性硬脑膜动静脉瘘 

分 类 号：R743[医药卫生—神经病学与精神病学]