Meng Xiaoli, Zhang Hongqi, Wang Yabing, Ye Ming, He Chuan, Du Jianxin, Ling Feng
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Xuanwu District, Beijing, People's Republic of China.
Childs Nerv Syst. 2010 Jul;26(7):889-96. doi: 10.1007/s00381-009-1071-8. Epub 2010 Jan 28.
The objective of this study was to review our pediatric series of perimedullary arteriovenous fistula (PMAVF), investigating the clinical characteristics, angioarchitecture, treatment strategy, and outcome of PMAVF in pediatric patients.
Nineteen children with PMAVF treated in Xuanwu Hospital between 1986 and 2007 were reviewed. The demographic data, clinical symptoms, angiographical characteristics, classification, treatment modality, and outcome were compiled and analyzed. Clinical status was evaluated according to the modified Aminoff and Logue scale.
In our pediatric series of PMAVF, the mean age of diagnosis was 8.1 years (range, 0.8-13.7 years). Male predominance was found in our series (M/F ratio, 3.75:1). Eleven children (57.9%) presented with acute onset of symptoms, and eight cases (42.1%) had progressive evolution of the diseases. In 13 cases (68.4%), the fistulas were classified as type III, with type II in six cases. Four lesions (21.1%) were located in the cervical region, with 15 lesions (78.9%) in thoracolumbar region. Ten cases (II = 2, III = 8) were treated with embolization, and nine (II = 4, III = 5) with combined embolization and complementary surgery. According to the criteria of therapeutic effectiveness, 31.6% of cases (6/19) were cured, and nine patients (47.4%) had improved.
PMAVFs in pediatric population exhibit many characteristics in clinical and angiographical aspects, need for special considerations. Most of PMAVFs in pediatric patients are high-flow fistulas, and endovascular embolization should be the first choice of treatment. After appropriate therapy, most of children can get satisfactory outcomes.
本研究旨在回顾我们的小儿髓周动静脉瘘（PMAVF）系列病例，探讨小儿PMAVF的临床特征、血管构筑、治疗策略及预后。
回顾了1986年至2007年在宣武医院接受治疗的19例小儿PMAVF患者。收集并分析了人口统计学数据、临床症状、血管造影特征、分类、治疗方式及预后。根据改良的阿明诺夫和洛格量表评估临床状况。
在我们的小儿PMAVF系列病例中，诊断时的平均年龄为8.1岁（范围0.8 - 13.7岁）。本系列病例中男性居多（男/女比例为3.75:1）。11例患儿（57.9%）症状急性发作，8例（42.1%）病情呈进行性发展。13例（68.4%）瘘管被分类为Ⅲ型，6例为Ⅱ型。4处病变（21.1%）位于颈部，15处病变（78.9%）位于胸腰段。10例（Ⅱ型2例，Ⅲ型8例）接受了栓塞治疗，9例（Ⅱ型4例，Ⅲ型5例）接受了栓塞联合辅助手术治疗。根据治疗效果标准，31.6%的病例（6/19）治愈，9例患者（47.4%）病情改善。
小儿PMAVF在临床和血管造影方面表现出许多特点，需要特殊考虑。小儿患者的大多数PMAVF为高流量瘘管，血管内栓塞应作为首选治疗方法。经过适当治疗，大多数患儿可获得满意的预后。
