Stiefel Michael F, Heuer Gregory G, Basil Anuj K, Weigele John B, Sutton Leslie N, Hurst Robert W, Storm Phillip B
Department of Neurosurgery and Division of Interventional Neuroradiology, University of Pennsylvania Medical Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
Neurosurgery. 2008 Nov;63(5):859-65; discussion 865-6. doi: 10.1227/01.NEU.0000327573.42267.CC.
Pediatric cerebral aneurysms are rare. There are very few recent studies that focus on the multidisciplinary treatment of ruptured aneurysms. We reviewed our pediatric endovascular and surgical experience with ruptured cerebral aneurysms.
Pediatric patients aged 16 years and younger who were admitted with a diagnosis of aneurysmal subarachnoid hemorrhage and treated at the Children's Hospital of Philadelphia were included in this analysis.
Twelve patients with 13 aneurysms (4 male patients and 8 female patients; age range, 4 months-16 years; mean age, 5.1 years), were admitted with subarachnoid hemorrhage during the past 12 years. The majority of patients were admitted in good clinical condition; 31% were in Hunt and Hess Grade II, and 31% were in Hunt and Hess Grade III. The remaining patients were in poor clinical condition and were in Hunt and Hess Grade IV (23%) or Grade V (15%). Computed tomography revealed that 15% of the patients were in Fisher Grade 2, 23% were in Fisher Grade 3, and 62% were in Fisher Grade 4. Endovascular techniques were used in the treatment of 5 aneurysms, and microsurgery was used in the treatment of 8 aneurysms. In the endovascular group, aneurysm sizes ranged from 2 to 35 mm (mean, 12.6 mm); 3 aneurysms were in the anterior circulation, and 2 were in the posterior circulation. In the microsurgery group, 6 aneurysms were in the anterior circulation, and 2 were in the posterior circulation; sizes ranged from 3 to 15 mm (mean, 6.8 mm). Sixty-nine percent of the patients were independent at follow-up.
Contemporary endovascular and microsurgical techniques can be used effectively to treat ruptured cerebral aneurysms in pediatric patients. In the time period studied, the techniques were equally effective when used in the appropriate patients.
小儿脑动脉瘤较为罕见。近期很少有研究关注破裂动脉瘤的多学科治疗。我们回顾了小儿破裂脑动脉瘤的血管内治疗和手术治疗经验。
本分析纳入了16岁及以下因动脉瘤性蛛网膜下腔出血入院并在费城儿童医院接受治疗的小儿患者。
在过去12年中，12例患者共13个动脉瘤（4例男性患者和8例女性患者；年龄范围4个月至16岁；平均年龄5.1岁）因蛛网膜下腔出血入院。大多数患者入院时临床状况良好；31%为Hunt和Hess分级II级，31%为Hunt和Hess分级III级。其余患者临床状况较差，为Hunt和Hess分级IV级（23%）或V级（15%）。计算机断层扫描显示，15%的患者为Fisher分级2级，23%为Fisher分级3级，62%为Fisher分级4级。5个动脉瘤采用血管内技术治疗，8个动脉瘤采用显微手术治疗。在血管内治疗组中，动脉瘤大小为2至35毫米（平均12.6毫米）；3个动脉瘤位于前循环，2个位于后循环。在显微手术组中，6个动脉瘤位于前循环，2个位于后循环；大小为3至15毫米（平均6.8毫米）。69%的患者在随访时能够独立活动。
当代血管内和显微手术技术可有效用于治疗小儿破裂脑动脉瘤。在所研究的时间段内，这些技术应用于合适的患者时效果相当。
