儿童颅内动脉瘤的临床特点和血管内治疗

Clinical features and endovascular treatment of pediatric intracranial aneurysms

目的 探讨儿童颅内动脉瘤的临床特点和血管内治疗.方法 回顾性分析首都医科大学北京市神经外科研究所神经介入中心2001年1月至2012年12月连续收治的35例（37个动脉瘤）行血管内治疗的儿童颅内动脉瘤患者（≤18岁）的临床资料,对35例患者的影像学特征、临床特征、血管内治疗方式和即刻栓塞结果进行分析和总结.35例患者均行血管内治疗.37个动脉瘤中,13个（35％）行单纯弹簧圈治疗,8个（22％）行支架辅助弹簧圈治疗,3个（8％）行单纯支架治疗,1个（3％）行球囊辅助治疗,6个（16％）行单纯载瘤动脉闭塞治疗,6个（16％）行载瘤动脉闭塞加弹簧圈治疗.结果 35例中,男30例（86％）,女5例（14％）（男∶女=6∶1）;前循环动脉动脉瘤15个（41％）,后循环动脉动脉瘤22个（59％）（前循环∶后循环=1.00∶1.47）;大动脉瘤（直径10～25 mm） 15个（41％）,巨大动脉瘤（直径＞25 mm）7个（19％）;复杂动脉瘤29个（78％）,蛛网膜下腔出血12例（34％）.术后即刻造影显示动脉瘤栓塞情况,Raymond分级Ⅰ级24个（65％）,Ⅱ级8个（22％）,Ⅲ级5个（13％）.术后随访3 ～32个月,以格拉斯哥预后分级（GOS）和影像学检查评估预后.血管内治疗后造影随访30例,复发4例（13％）.临床随访32例,GOS恢复良好20例,中残8例,重残3例,植物生存1例,无死亡病例.结论 儿童颅内动脉瘤男性多发,好发于后循环,大型及巨大型、创伤性、夹层、梭形及不规则形等复杂动脉瘤多见,血管内治疗效果和预后良好.

Objective To investigate the clinical features and endovascular treatment of pediatric intracranial aneurysms.Methods The clinical data of 35 consecutive children （≤ 18 years） with intracranial aneurysm （37 aneurysms） admitted to Intervention Center,Beijing Neurosurgical Institute,Capital Medical University and treated with endovascular treatment from January 2001 to December 2012 were analyzed retrospectively.The imaging characteristics,clinical characteristics,endovascular treatment modalities and immediate results of embolization in 35 children were analyzed and summarized.All 35 patients underwent endovascular treatment.Of the 37 aneurysms,13 （35%） were treated with coil treatment alone,8 （22%） were treated with stent assisted coil embolization,3 （8%） were treated with stents alone,1 （3%） was treated with balloon-assisted therapy,6 （16%） were treated with parent artery occlusion alone,and 6 （16%） were treated with parent artery occlusion and coils.Results Of the 35 children,30 （86%） were males,5 （14%） were females （male∶ female =6∶1） ; there were 15 （41%） anterior circulation aneurysms and 22 （59%） posterior circulation aneurysms （anterior circulation：posterior circulation =1.00∶ 1.47） ; there were 15 （41%） large aneurysms （diameter 10-25 mm） and 7 （19%） giant aneurysms （diameter ≥25 mm）.There were 29 （78%） complex aneurysms.Twelve patients had （34%） subarachnoid hemorrhage.Immediate postoperative angiography showed aneurysm embolization.Raymond classification showed that 24 aneurysms （65%） were grade Ⅰ,8 （22%） were grade Ⅱ,and 5 （13%） were grade Ⅲ.They were followed up for 3 to 32 months after surgery.Glasgow outcome scale （GOS） and imaging examination were used to evaluate prognosis.Thirty children were followed up with angiography after endovascular treatment and 4 （13%） relapsed.Thirty-two children were followed up by telephone.GOS assessment showed that the postoperative recovery was good in 20 children,8 had moderate disability,3 had severe disability,1 was in a vegetative state,and no one was dead.Conclusions Pediatric intracranial aneurysms have male predominance.They often occur in complex aneurysms,such as posterior circulation,large and giant,traumtic,dissection,fusiform,and irregularly aneurysms.The effect of endovascular treatment and prognosis are good.