Zhang Helen J, Silva Nicole, Solli Elena, Ayala Amanda C, Tomycz Luke, Christie Catherine, Mazzola Catherine A
Brown University, 69 Brown Street, Providence, RI, 02912, USA.
Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA.
Childs Nerv Syst. 2020 Dec;36(12):3147-3152. doi: 10.1007/s00381-020-04624-4. Epub 2020 May 6.
A 16-month-old female was admitted for prolonged fever, gait ataxia, and neurogenic bowel and bladder. Neurological exam was significant for decreased sensory and motor functions in bilateral lower extremities. Initial MRI showed a thoracic spine hematoma and diagnostic angiogram revealed a large AVM and aneurysm. The patient underwent surgical resection of the hematoma and AVM, as well as clipping and later endovascular coiling of the aneurysm. Due to significant hemorrhage perioperatively, she developed spastic paraplegia improved by baclofen and onabotulinumtoxin A injections. The aims of this paper were to conduct a systematic review of the literature on pediatric spinal cord vascular malformations and analyze trends in treatment options and long-term neurological outcomes. PubMed searches were conducted using keywords "pediatric spinal vascular malformation" and "pediatric spinal AVM", yielding 34 results after abstract screening and cross-reference. Endovascular embolization was determined to have better long-term outcomes, with 10/19 (52.6%) patients with postoperative complications associated with open vascular surgeries. Open versus endovascular surgical decisions can be difficult with unique spinal AVM pathologies in pediatric patients. Important considerations such as size, location, neurological deficits, and risk of rupture are important factors to consider in treating these patients. We recommend endovascular treatment as a first-line approach due to lower risk of hemorrhage and postoperative deficits.
一名16个月大的女性因长期发热、步态共济失调以及神经源性肠道和膀胱功能障碍入院。神经系统检查显示双侧下肢感觉和运动功能减退。最初的MRI显示胸椎血肿，诊断性血管造影显示一个大的动静脉畸形（AVM）和动脉瘤。患者接受了血肿和AVM的手术切除，以及动脉瘤夹闭术，随后进行了动脉瘤血管内栓塞术。由于围手术期大量出血，她出现了痉挛性截瘫，通过巴氯芬和A型肉毒毒素注射后有所改善。本文的目的是对小儿脊髓血管畸形的文献进行系统综述，并分析治疗选择和长期神经学结果的趋势。使用关键词“小儿脊髓血管畸形”和“小儿脊髓AVM”在PubMed上进行检索，经过摘要筛选和交叉引用后得到34个结果。血管内栓塞术被确定具有更好的长期结果，19例接受开放血管手术的患者中有10例（52.6%）出现术后并发症。对于小儿患者独特的脊髓AVM病变，开放手术与血管内手术的决策可能很困难。大小、位置、神经功能缺损以及破裂风险等重要因素是治疗这些患者时需要考虑的重要因素。由于出血风险和术后缺损较低，我们建议将血管内治疗作为一线治疗方法。
