Blondin D, Turowski B, Mödder U, Schaper J
Institut für Diagnostische Radiologie, Universitätsklinikum Düsseldorf.
Radiologe. 2006 Feb;46(2):144-9. doi: 10.1007/s00117-006-1347-x.
Intracranial vascular malformations (IVM) on the whole occur in neonates very rarely. In such cases of IVM two different kinds can and must be discerned: (1) dural arteriovenous shunts (DAVS) and (2) vein of Galen aneurysmal malformations (VGAM). The latter seem to represent the majority of IVM of newborns. Several classifications are known for both types. Mortality of neonates and babies due to DAVS exceeds the average mortality from DAVS in adults. VGAM and DAVS can be diagnosed by prenatal ultrasonography only when the vessels behind the shunt are vasodilated because of the increasing flow stress. For that reason VGAM and DAVS are generally not recognized before the last trimenon or even postnatally. The prognosis of an IVM is influenced by the shunt capacity and its resulting cardiac stress as well as by the child's age. To plan the mostly interventional therapy, postnatal angiography (DSA) and MRI are employed and to an increasing extent also prenatal MRI examinations. We describe the case of a very complex IVM, the full dimensions of which could only be discerned by using pre- and postnatal MRI supplementary to the ultrasonography. Besides DAVS, flows from the pericallosal arteries as well as from the thalamic branches had to be considered. As a consequence DAVS and in addition VGAM existed in parallel.
颅内血管畸形（IVM）总体上在新生儿中极为罕见。在IVM的此类病例中，可以且必须区分出两种不同类型：（1）硬脑膜动静脉分流（DAVS）和（2）大脑大静脉动脉瘤样畸形（VGAM）。后者似乎占新生儿IVM的大多数。这两种类型都有几种分类方法。新生儿和婴儿因DAVS导致的死亡率超过成人DAVS的平均死亡率。仅当分流后方的血管因血流压力增加而扩张时，才能通过产前超声诊断VGAM和DAVS。因此，VGAM和DAVS通常在妊娠晚期之前甚至出生后才被识别。IVM的预后受分流能力及其导致的心脏压力以及患儿年龄的影响。为了规划大多数情况下的介入治疗，会采用产后血管造影（DSA）和MRI，并且产前MRI检查的应用也越来越多。我们描述了一例非常复杂的IVM病例，其全貌只能通过超声检查辅以产前和产后MRI才能看清。除了DAVS外，还必须考虑来自胼周动脉以及丘脑分支的血流。因此，DAVS与VGAM并存。
