儿童颅内动脉瘤的临床特点与治疗分析

Clinical characteristics and treatment of intracranial aneurysms in children

目的探讨儿童颅内动脉瘤的临床特点、治疗方法及其疗效。方法回顾性分析2012年1月至2023年1月收治的33例小儿颅内动脉瘤的临床资料。结果年龄6~17岁,平均(13.7±15.1)岁。33例共35枚动脉瘤,其中前循环26枚,后循环9枚;26例呈急性发病,合并蛛网膜下腔出血17例、脑内血肿8例、血肿破入脑室3例、脑积水1例。12例采取动脉瘤夹闭术,术后6个月mRS评分0~1分10例,2分1例,3分1例。7例选择血管内治疗,术后6个月mRS评分0~1分。3例巨大、夹层动脉瘤行颅外-颅内动脉分流术,术后6个月mRS评分0、1、2分各1例。10例选择保守治疗,6个月随访期内未新发卒中事件。1例放弃治疗,自动出院1周后死亡。结论儿童颅内动脉瘤以男性多见,后循环动脉瘤占比高,临床症状多样;治疗上,建议首选动脉瘤夹闭术,对后循环动脉瘤及巨大、夹层动脉瘤,则可以选择血管内治疗或颅外-颅内动脉分流术。

Objective To investigate the clinical features,and treatment methods and outcomes of intracranial aneurysms in children.Methods The clinical data of 33 children with intracranial aneurysms who were admitted to our hospital from January 2012 to January 2023 were retrospectively analyzed.Results The average age was(13.7±15.1)years,ranging from 6 to 17 years.There were 35 aneurysms in 33 patients,including 26 aneurysms in anterior circulation and 9 aneurysms in posterior circulation.Of 26 patients with acute onset,17 had subarachnoid hemorrhage,8 intracerebral hematoma,3 hematoma braking into the ventricle,and 1 hydrocephalus.A mRS score of 0~1 was achieved in 10 children and a score of 2~3 in 2 children of 12 children receiving aneurysmal clipping at 6 months after surgery.A mRS score of 0~1 was achieved in 7 children receiving endovascular treatment at 6 months after operation.A mRS score of 0,1,and 2 was achieved in 3 childred with large or dissected aneurysms receiveing extra-intra cranial bypass at 6 months after operation,respectively.No new stroke occurred in 10 patients recieving conservative treatment during the 6-month follow-up.One case gave up treatment and died 1 week after discharge.Conclusions Pediatric intracranial aneurysms are more common in male children,with a higher proportion of posterior circulation aneurysms and diverse clinical symptoms.Aneurysmal clipping is recommended as the first choice,and endovascular treatment or extra-intra cranial bypass can be selected for posterior circulation aneurysms,giant aneurysms or dissecting aneurysms.