Maggi G, Petrone G, Aliberti F, Colucci M R, Varone A
Neurosurgical Division of Santobono Hospital, Naples, Italy.
J Neurosurg Sci. 1994 Dec;38(4):255-8.
Intramedullary arteriovenous malformations are rare in childhood. Yasargil reports only two cases in children under ten years of age out of a total of forty-one cases of AVM operated on between 1967 and 1983 in which microsurgical techniques were used. The early symptoms of these lesions are those due to intramedullary or subarachnoid haemorrhage with neurological deficit, pain and/or weakness or numbness of one or more limbs. We report the case of an intramedullary haematoma due to arteriovenous malformation within the medulla oblongata in a three year old child admitted for cervical pain and right arm hypostenia. The CT scan and MRI showed an intramedullary expansive lesion with associated internal haematoma between C1-C7 level. Because of the rapid clinical deterioration upon the onset of right hemiparesis we procedeed to empty the intramedullary haematoma and to remove the intrabulbar AVM. A swift improvement of neurological deficit was observed along with a total regression of the symptomatology in a month's time. The excellent results reported in this case, very likely the only case in the literature occurring in a very small child at this spinal cord level, are mostly due to the early surgical treatment and to the exact information that MRI provided.
髓内动静脉畸形在儿童期较为罕见。亚萨吉尔报告称，在1967年至1983年间采用显微外科技术手术治疗的41例动静脉畸形病例中，10岁以下儿童仅有2例。这些病变的早期症状是由于髓内或蛛网膜下腔出血伴神经功能缺损、疼痛和/或一个或多个肢体无力或麻木。我们报告了一例3岁儿童因延髓内动静脉畸形导致髓内血肿的病例，该患儿因颈部疼痛和右臂张力减退入院。CT扫描和MRI显示在C1 - C7水平有一个髓内扩张性病变并伴有内部血肿。由于右侧偏瘫发作后临床迅速恶化，我们进行了髓内血肿清除及延髓内动静脉畸形切除术。观察到神经功能缺损迅速改善，一个月内症状完全消退。该病例报告的出色结果，很可能是文献中该脊髓水平在极小儿童中发生的唯一病例，主要归功于早期手术治疗以及MRI提供的准确信息。
