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目的 探讨小儿脑血管畸形的影像学特征及血管内治疗的方法与效果。方法 回顾性研究近 9年我院收治的小儿脑血管畸形 6 5例 ,男 37例 ,女 2 8例。所有患儿均行选择性全脑血管造影明确诊断 ,并行血管内栓塞治疗。栓塞材料采用真丝线段 2 9例 ,NBCA胶栓塞 2 1例 ,真丝线段与NBCA胶联合栓塞 15例。结果 脑血管造影显示 :血管畸形位于基底节及中线部位为主者 2 8例 ,以皮层为主者 2 3例 ,后颅窝 14例。颈内动脉分支供血 7例 ,大脑前动脉分支供血者 38例 ,大脑中动脉分支供血 2 9例 ,大脑后动脉分支供血 19例 ,基底动脉分支供血 14例。病灶最大直径 5 .0cm× 5 .0cm× 6 .0cm。最小直径 2 .0cm× 3.0cm× 3.0cm。血管内治疗一次栓塞 4 3例 ,二次栓塞治疗 18例 ,4例巨大型病灶行三次栓塞。 2 4例解剖治愈 ,病灶闭塞 80 %～ 90 % 2 1例 ,闭塞 6 0 %～ 70 % 15例 ,闭塞5 0 %以下 5例。 38例随访 5个月至 9年 ,18例解剖治愈者无复发 ,残存病灶者中有 2例分别于术后2个月、3年再次出血 ,其中 1例死亡 ,1例偏瘫。 1例术后 3个月死于充血性心力衰竭。结论 血管内治疗对小儿脑血管畸形是有效的和安全的治疗方法。
Objective To investigate the imaging features of cerebrovascular malformations in children and the methods and effects of intravascular treatment. Methods Retrospective study of 65 cases of cerebrovascular malformations in children admitted to our hospital in recent 9 years, 37 males and 28 females. All children underwent selective whole cerebral angiography to confirm the diagnosis, and endovascular embolization. Embolization material using 29 silk lines, NBCA plastic plug in 21 cases, silk thread and NBCA glue in combination with embolization in 15 cases. Results Cerebral angiography showed that vascular malformations were mainly found in 28 cases of basal ganglia and midline, 23 cases were cortical and 14 cases were posterior fossa. 7 cases of internal carotid artery branch supply, 38 cases of anterior branch of cerebral artery blood supply, 29 cases of middle cerebral artery branch supply, 19 cases of posterior cerebral artery branch supply and 14 cases of basilar artery branch supply. The maximum diameter of the lesion 5 .0cm × 5 .0cm × 6 .0cm. The smallest diameter 2.0 cm × 3.0 cm × 3.0 cm. Endovascular treatment of an embolism in 43 cases, 18 cases of second embolization, 4 cases of giant lesions three embolization. Twenty-four cases were cured by anatomy, 80 cases were occluded from 80% to 90%, 15 cases were occluded from 60% to 70%, and 5 cases were occluded below 50%. Thirty-eight patients were followed up for 5 months to 9 years. There were no recurrences in 18 cases of healed anastomosis. Two of the remaining lesions were hemorrhaged again at 2 months and 3 years after operation, of which 1 died and 1 hemiparesis. One patient died of congestive heart failure 3 months after operation. Conclusion Endovascular treatment of cerebral vascular malformations in children is an effective and safe treatment.