Meila Dan, Lisseck Kathrin, Jacobs Collin, Lanfermann Heinrich, Brassel Friedhelm, Feldkamp Axel
Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Carl-Neuberg-Str.1, 30625, Hannover, Germany,
Neuroradiology. 2015 Feb;57(2):211-9. doi: 10.1007/s00234-014-1455-7. Epub 2014 Oct 25.
Vein of Galen malformation (VGM) is the severest paediatric neurovascular disease usually requiring multiple staged embolisations. In the high-risk group of children with high-flow arteriovenous shunts, timing of treatment is uncertain. Low Doppler resistance index (RI) is known to be associated with adverse outcome in hypoxic-ischaemic brain injury in children. In this study, we want to present our long-term results of cranial transfontanellar Doppler ultrasound in children with VGM.
We identified and retrospectively analysed 264 transfontanellar Doppler measurements in 19 endovascular-treated true VGM (five females, 14 males) between 2000 and 2013. The recordings were obtained from the internal carotid arteries (ICA), the anterior cerebral arteries (ACA) and the basilar arteries (BA). Maximal systolic velocity (Vs), end-diastolic velocity (Ved) and the RI were measured before and after embolisation.
Untreated, nearly all cases showed pathologic high systolic (up to >1.0 m/s), very high diastolic velocities (up to >0.5 m/s) and low RI (<0.6). There were statistically significant differences (p = 0.012) between the pre-embolisation RI and the post-embolisation RI with pathologic low RI before and nearly normal RI after successful shunt reduction.
Successful endovascular shunt reduction in VGM leads to significant changes of cranial Doppler RI from pathologic low values to normal values. We propose cranial Doppler ultrasound as an adjunctive technique to other screenings in the management of VGM. Further research is warranted to evaluate the role of the RI in the treatment timing decision.
大脑大静脉畸形（VGM）是最严重的儿科神经血管疾病，通常需要多次分期栓塞治疗。在高流量动静脉分流的高危儿童群体中，治疗时机尚不确定。已知低多普勒阻力指数（RI）与儿童缺氧缺血性脑损伤的不良预后相关。在本研究中，我们希望展示我们对患有VGM的儿童进行经囟门颅多普勒超声检查的长期结果。
我们确定并回顾性分析了2000年至2013年间19例接受血管内治疗的真性VGM（5名女性，14名男性）的264次经囟门多普勒测量结果。记录取自颈内动脉（ICA）、大脑前动脉（ACA）和基底动脉（BA）。在栓塞前后测量最大收缩速度（Vs）、舒张末期速度（Ved）和RI。
未经治疗时，几乎所有病例均显示病理性高收缩速度（高达>1.0 m/s）、非常高的舒张速度（高达>0.5 m/s）和低RI（<0.6）。栓塞前RI与栓塞后RI之间存在统计学显著差异（p = 0.012），栓塞前RI病理性降低，成功减少分流后RI接近正常。
成功进行血管内分流减少治疗VGM可导致颅多普勒RI从病理性低值显著变化为正常数值。我们建议将颅多普勒超声作为VGM管理中其他筛查的辅助技术。有必要进一步研究以评估RI在治疗时机决策中的作用。
