Yu Jinlu, Lv Xianli, Li Youxiang, Wu Zhongxue
Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China Beijing Tiantan Hospital, Beijing, China.
Interv Neuroradiol. 2016 Oct;22(5):548-56. doi: 10.1177/1591019916653254. Epub 2016 Jun 15.
Pediatric dural arteriovenous shunts (dAVSs) are a rare form of vascular disease: Fewer than 100 cases are reported in PubMed and the understanding of pediatric dAVS is limited. For this study, we searched in PubMed, reviewed and summarized the literature related to pediatric dAVSs. Our review revealed that pediatric dAVSs have an unfavorable natural history: If left untreated, the majority of pediatric dAVSs deteriorate. In a widely accepted classification scheme developed by Lasjaunias et al., pediatric dAVSs are divided into three types: Dural sinus malformation (DMS) with dAVS, infantile dAVS (IDAVS) and adult-type dAVS (ADAVS). In general, the clinical manifestations of dAVS can be summarized as having symptoms due to high-flow arteriovenous shunts, symptoms from retrograde venous drainage, symptoms from cavernous sinus involvement and hydrocephalus, among other signs and symptoms. The pediatric dAVSs may be identified with several imaging techniques; however, the gold standard is digital subtraction angiography (DSA), which indicates unique anatomical details and hemodynamic features. Effectively treating pediatric dAVS is difficult and the prognosis is often unsatisfactory. Transarterial embolization with liquid embolic agents and coils is the treatment of choice for the safe stabilization and/or improvement of the symptoms of pediatric dAVS. In some cases, transumbilical arterial and transvenous approaches have been effective, and surgical resection is also an effective alternative in some cases. Nevertheless, pediatric dAVS can have an unsatisfactory prognosis, even when timely and appropriate treatment is administered; however, with the development of embolization materials and techniques, the potential for improved treatments and prognoses is increasing.
小儿硬脑膜动静脉分流术（dAVS）是一种罕见的血管疾病：在PubMed上报道的病例少于100例，对小儿dAVS的了解有限。在本研究中，我们在PubMed中进行检索，回顾并总结了与小儿dAVS相关的文献。我们的综述显示，小儿dAVS具有不良的自然病程：如果不进行治疗，大多数小儿dAVS会恶化。在Lasjaunias等人制定的一个广泛接受的分类方案中，小儿dAVS分为三种类型：伴有dAVS的硬脑膜窦畸形（DMS）、婴儿型dAVS（IDAVS）和成人型dAVS（ADAVS）。一般来说，dAVS的临床表现可概括为由高流量动静脉分流引起的症状、逆行静脉引流引起的症状、海绵窦受累引起的症状和脑积水，以及其他体征和症状。小儿dAVS可以通过几种成像技术来识别；然而，金标准是数字减影血管造影（DSA），它能显示独特的解剖细节和血流动力学特征。有效治疗小儿dAVS很困难，预后往往不理想。使用液体栓塞剂和弹簧圈进行经动脉栓塞是稳定小儿dAVS症状和/或改善症状的首选治疗方法。在某些情况下，经脐动脉和经静脉途径也有效，手术切除在某些情况下也是一种有效的替代方法。尽管如此，即使给予及时恰当的治疗，小儿dAVS的预后仍可能不理想；然而，随着栓塞材料和技术的发展，改善治疗和预后的可能性正在增加。
