[儿童和青少年脑动脉的动脉瘤]

Pilipenko Iu V, Eliava Sh Sh, Filatov Iu M, Iakovlev S B, Khukhlaeva E A, Kheĭreddin A S

Zh Vopr Neirokhir Im N N Burdenko. 2009 Oct-Dec(4):24-30; discussion 30-1.

BACKGROUND

Intracranial aneurysms are rare lesions in children and adolescents and their epidemiology, clinical and anatomic features are poorly understood. Aim of the study was to reveal the specific features of cerebral aneurysms in children and adolescents and to develop guidelines for management of these patients.

MATERIALS AND METHODS

The study was performed on consecutive series of 125 patients under 18 years of age harboring 145 aneurysms. All of them were treated in Burdenko Neurosurgical Institute (Moscow, Russia) from 1987 to 2007.

RESULTS

Specific features of pediatric aneurysms include: high incidence on a background of connective tissue disorder (42%) and abnormalities of circle of Willis (20%), frequent localization in bifurcation of internal carotid artery (13.8%), its cavernous segment (17.9%), or in posterior part of circle of Willis (23.5%). In children giant aneurysms were observed in 31.7% of cases, fusiform in 19.3% and partially thrombosed in 33.8%. Complications of aneurysms in children with hemorrhagic type of course included recurrent hemorrhages (42.9%), hematomas (31%), hydrocephalus (16.7%) and seizures (33.3%). Generally, 107 pediatric patients (85.6%) with 118 aneurysm (81.4%) were operated. Microsurgical treatment was performed in 57% of patients and endovascular procedures in 43% In the series of 107 operated patients we observed excellent early postoperative results in 53 cases (49.5%), good in 45 (42.1%) and poor in 9 (8.4%). Postoperative mortality was 0.95% (1 patient).

CONCLUSION

Considerable proportion of complex aneurysms in children and adolescents produces certain difficulties of treatment; however, due to good functional outcomes in this age group the range of causes of denial must be minimized.

背景

颅内动脉瘤在儿童和青少年中是罕见病变，其流行病学、临床及解剖学特征尚不清楚。本研究的目的是揭示儿童和青少年脑动脉瘤的具体特征，并制定这些患者的管理指南。

材料与方法

对连续收治的125例18岁以下患有145个动脉瘤的患者进行了研究。所有患者均于1987年至2007年在布尔坚科神经外科研究所（俄罗斯莫斯科）接受治疗。

结果

儿童动脉瘤的具体特征包括：结缔组织疾病背景下的高发病率（42%）和 Willis 环异常（20%），频繁定位于颈内动脉分叉处（13.8%）、海绵窦段（17.9%）或 Willis 环后部（23.5%）。儿童中巨大动脉瘤占31.7%，梭形动脉瘤占19.3%，部分血栓形成的动脉瘤占33.8%。出血型病程的儿童动脉瘤并发症包括反复出血（42.9%）、血肿（31%）、脑积水（16.7%）和癫痫发作（33.3%）。总体而言，107例（85.6%）患有118个动脉瘤（81.4%）的儿童患者接受了手术。57%的患者进行了显微外科治疗，43%的患者进行了血管内手术。在107例接受手术的患者中，我们观察到术后早期效果极佳的有53例（49.5%），良好的有45例（42.1%），较差的有9例（8.4%）。术后死亡率为0.95%（1例患者）。