Maruyama Daisuke, Kataoka Hiroharu, Satow Tetsu, Mori Hisae, Ito Yoshiro, Hamano Eika, Tanaka Shunichi, Ishiguro Taichi, Chikuie Hidekazu, Takahashi Jun C
Department of Neurosurgery, National Cerebral and Cardiovascular Center.
Neurol Med Chir (Tokyo). 2018 Aug 15;58(8):334-340. doi: 10.2176/nmc.st.2018-0034. Epub 2018 Jul 12.
Antithrombotic treatment has substantial risks, even in pediatric patients. We retrospectively evaluated the management and outcomes of consecutive pediatric patients who underwent neurosurgical treatment for cerebrovascular disease with cardiovascular disease between 1998 and 2017. Patients were divided into patients with comorbid cardiovascular disease (group I); and patients with cardiovascular disease as a primary disease of intracranial complication, without (group IIa) or with (group IIb) extracorporeal circulations. Postoperative resumption of antithrombotic agents was generally initiated within 48 h. Our study included 26 patients; five were categorized as group I, 15 as group IIa, and six as group IIb. All intracranial diseases in groups IIa and IIb were exclusively hemorrhagic. Preoperative anticoagulation therapy was used in one patient (20%) in group I, 13 patients (86.7%) in group IIa, and six patients (100%) in group IIb. Postoperative intracranial hemorrhagic events were observed in one patient (20%) in group I, three patients (20%) in group IIa, and four patients (66.7%) in group IIb. Re-operations were conducted in two (13.3%) and three patients (50%) in groups IIa and IIb, respectively. Death occurred in five (33.3%) and four patients (66.7%) in groups IIa and IIb, respectively. The remaining two patients in group IIb returned to candidate status for implantation. Emergent surgery for patients with intracranial hemorrhage associated with cardiovascular disease has a high risk of postoperative hemorrhagic events and high rate of re-operations with poor vital outcomes, especially in patients with extracorporeal circulations. We should consider maximum neurosurgical treatment achievable with optimal management of antithrombotic treatment.
抗血栓治疗存在重大风险，即使在儿科患者中也是如此。我们回顾性评估了1998年至2017年间因脑血管疾病合并心血管疾病而接受神经外科治疗的连续儿科患者的治疗管理及预后情况。患者被分为合并心血管疾病的患者（I组）；以及以心血管疾病作为颅内并发症原发疾病的患者，其中未进行体外循环的患者（IIa组）和进行体外循环的患者（IIb组）。术后抗血栓药物的恢复通常在48小时内开始。我们的研究纳入了26例患者；5例归类为I组，15例为IIa组，6例为IIb组。IIa组和IIb组的所有颅内疾病均为出血性疾病。I组1例患者（20%）、IIa组13例患者（86.7%）以及IIb组6例患者（100%）术前使用了抗凝治疗。I组1例患者（20%）、IIa组3例患者（20%）以及IIb组4例患者（66.7%）术后发生了颅内出血事件。IIa组和IIb组分别有2例（13.3%）和3例患者（50%）进行了再次手术。IIa组和IIb组分别有5例（33.3%）和4例患者（66.7%）死亡。IIb组其余2例患者恢复到植入候选状态。对于合并心血管疾病的颅内出血患者进行急诊手术，术后出血事件风险高，再次手术率高，且重要预后差，尤其是在进行体外循环的患者中。我们应考虑在对抗血栓治疗进行最佳管理的情况下，实现最大程度的神经外科治疗。
