Meljnikov Igor, Vuleković Petar, Cigić Tomislav, Borisev Vladimir, Milojević Aleksandar, Iduski Stevan
Department of Pediatric Surgery, Institute for Child and Youth Health Care of Vojvodina, Novi Sad.
Med Pregl. 2012 Jul-Aug;65(7-8):331-6.
Despite the contemporary diagnostics of intracranial aneurysms their treatment is still a great challenge. The decision when and if to apply a surgical or endovascular treatment of intracranial aneurysms should be made by a team of medical specialists which consists of a cerebrovascular neurosurgeon, neuro-radiologist and neuro-anesthesiologist.
We report a case of a patient aged 16 who was admitted because of a sudden intensive headache followed by sickness, vomiting, and loss of consciousness. On admission the patient was conscious but sleepy. Glasgow Coma Scale score was 14 and the World Federation of Neurological Surgeons Scale grade was I. The computed tomography scan showed a massive subarachnoid haemorrhage. The computed tomography angiography and digital subtraction angiography revealed a ruptured saccular aneurysm in the left vertebral artery. An early treatment with the coiling of the lumen of the aneurysm was performed under general anaesthesia. On the tenth day the boy was discharged in good condition and without any neurological deficits. Six months after the intervention the patient was without symptoms and the control digital subtraction angiography showed the complete occlusion of the aneurysm.
Intracranial aneurysms in children are more common in males and are predominantly localized in the posterior circulation. In addition, they are frequently of greater size and more complex architecture and they are associated with a lower incidence of clinically manifest vasospasm. According to previous experience, endovascular treatment of intracranial aneurysms in paediatric patients has proven to be a safe and efficient method with a small number of complications.
尽管目前对颅内动脉瘤的诊断技术不断发展，但对其治疗仍然是一项巨大挑战。颅内动脉瘤何时以及是否应采用手术或血管内治疗的决策应由一个医学专家团队做出，该团队由脑血管神经外科医生、神经放射科医生和神经麻醉科医生组成。
我们报告一例16岁患者，因突发剧烈头痛，随后出现恶心、呕吐及意识丧失入院。入院时患者意识清醒但嗜睡。格拉斯哥昏迷量表评分为14分，世界神经外科联合会分级为I级。计算机断层扫描显示大量蛛网膜下腔出血。计算机断层血管造影和数字减影血管造影显示左椎动脉有一个破裂的囊状动脉瘤。在全身麻醉下对动脉瘤腔进行了早期弹簧圈栓塞治疗。术后第10天，患儿状况良好出院，无任何神经功能缺损。干预6个月后，患者无症状，复查数字减影血管造影显示动脉瘤完全闭塞。
儿童颅内动脉瘤在男性中更为常见，主要位于后循环。此外，它们通常体积更大、结构更复杂，且临床明显血管痉挛的发生率较低。根据以往经验，小儿颅内动脉瘤的血管内治疗已被证明是一种安全有效的方法，并发症较少。
