儿童脑动静脉瘘的临床表现、血管构筑特征及治疗结局分析  

Clinical manifestations,vascular architecture characteristics and treatment outcomes of pediatric cerebral arteriovenous fistula

作　　者：张毅 薛萍 廖煜君 徐斌 田彦龙 李昊 Zhang Yi;Xue Ping;Liao Yujun;Xu Bin;Tian Yanlong;Li Hao(Department of Neurosurgery,Children’s Hospital of Fudan University,Shanghai 201102,China;Department of Neurosurgery,Affiliated Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属儿科医院神经外科,上海201102 [2]复旦大学附属华山医院神经外科,上海200040

出　　处：《临床小儿外科杂志》2025年第2期109-113,共5页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(82101810)。

摘　　要：目的总结儿童脑动静脉瘘的治疗方案和临床疗效,探讨脑动静脉瘘的临床和影像学特点以及疗效相关因素。方法回顾性分析2016年10月至2024年10月复旦大学附属儿科医院神经外科收治的脑动静脉瘘患儿临床资料,总结患儿临床表现、影像学特征、治疗方案及预后情况。结果共收治脑动静脉瘘患儿24例,男16例、女8例,年龄(3.1±2.89)岁(2.5个月至10岁)。临床表现为偏瘫、颅内出血和癫痫各7例,发育迟缓6例,头面部静脉扩张和头痛各5例,头围增大4例,心力衰竭1例,突眼1例。分型为软脑膜动静脉瘘15例,硬脑膜动静脉瘘4例,盖伦静脉瘤样畸形5例。患儿均接受介入治疗,6例于介入治疗后行伽马刀治疗。随访时间(51.7±26.39)个月(6.9~98.3个月),随访期间10例获得影像学治愈,18例临床预后良好。存在静脉窦内逆流(P=0.017)、合并其他血管畸形(P=0.046)、发生术后并发症(P=0.011)以及影像学治愈(P=0.017)是临床预后不良的风险因素。多动脉供血(P<0.001)、多个瘘口(P=0.005)及经横窦引流(P=0.034)是影响影像学治愈的相关因素。结论儿童脑动静脉瘘临床表现多样,介入治疗安全有效,介入治疗的疗效与动静脉瘘血管构筑特点相关。影像学上瘘口完全闭塞有助于获得良好的临床预后。Objective To summarize the treatment protocols and clinical outcomes of pediatric cerebral arteriovenous fistula(AVF)and explore the clinical and radiological characteristics as well as factors associated with therapeutic efficacy.Methods A retrospective analysis was conducted for the relevant clinical data of 24 children with cerebral AVF admitted into Department of Neurosurgery,Children’s Hospital of Fudan University from October 2016 to October 2024.The clinical manifestations,radiological features,treatment protocols and prognostic follow-ups were summarized.Results There were 16 boys and 8 girls with an average age of(3.1±2.89 year)(2.5 month-10 year).The clinical manifestations included hemiplegia(n=7),intracranial hemorrhage(n=7),epilepsy(n=7),developmental delay(n=6),facial and scalp venous dilation(n=5),headache(n=5),expanded head circumference(n=4),heart failure in 1 case and exophthalmos(n=1).The clinical types were pial AVF(n=15),dural AVF(n=4)and Galen vein aneurysmal malformation(n=5).All of them received interventional treatment and 6 cases had gamma knife treatment after interventional therapy.During a follow-up period of(51.7±26.39)(6.9-98.3)month.the outcomes were radiological cure(n=10)and good clinical prognosis(n=18).Presence of venous sinus reflux(P=0.017),co-existence of other vascular malformations(P=0.046),occurrence of postoperative complications(P=0.011)and radiological cure(P=0.017)were risk factors affecting clinical outcomes.Multiple arterial supplies(P<0.001),multiple fistulas(P=0.005)and drainage through transverse sinus(P=0.034)were factors associated with radiological cure.Conclusions Pediatric cerebral AVF presents with diverse clinical manifestations.Endovascular interventional treatment is both safe and effective and its efficacy is correlated with vascular architecture of AVF.Complete obliteration of fistula contributes to favorable clinical outcomes.

关 键 词：动静脉瘘 脑 症状和体征 介入治疗 伽马刀治疗 儿童 

分 类 号：R726.5[医药卫生—儿科]