Ventureyra E C, Higgins M J
Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada.
Childs Nerv Syst. 1994 Aug;10(6):361-79. doi: 10.1007/BF00335125.
We report four pediatric traumatic intracranial aneurysms occurring before the age of 10 years. Two of these aneurysms were the result of closed head injury. The remaining two were iatrogenic aneurysms which occurred in unusual circumstances. These four children represent 33% of the pediatric intracranial aneurysms seen at the Children's Hospital of Eastern Ontario from 1974 to 1992. Diagnosis of traumatic intracranial aneurysms requires a high index of suspicion: any head-injured or postoperative child who experiences delayed neurologic deterioration, or who fails to improve as expected following treatment, should promptly undergo diagnostic intracranial imaging. Documented subarachnoid hemorrhage, intracerebral or intraventricular hemorrhage, or subdural haematoma in this clinical setting should be further investigated by cerebral angiography to exclude a traumatic aneurysm or other vascular lesion. Traumatic aneurysms typically arise at the skull base or from distal anterior or middle cerebral arteries or branches consequent to direct mural injury or to acceleration-induced shear. Reported traumatic aneurysms account for 14%-39% of all pediatric aneurysms. Iatrogenic aneurysms also occur with unexpected frequency during childhood and adolescence. Pediatric traumatic cerebral aneurysms may present early or late. Most present early with intracranial hemorrhage. Late presentation occurs infrequently, typically as an aneurysmal mass. Once diagnosed, these aneurysms should be promptly treated by craniotomy employing routine microsurgical techniques, or in some cases, by endovascular detachable balloon techniques. Delay in operative treatment entails significant risks of repeated hemorrhage and death. Outcome in these children is primarily determined by the extent of traumatic cerebral injury and the preoperative clinical status. The latter directly depends upon diagnosis of the aneurysm prior to either initial or repeated hemorrhage.
我们报告了4例10岁前发生的儿童创伤性颅内动脉瘤。其中2例动脉瘤是闭合性颅脑损伤的结果。其余2例是在特殊情况下发生的医源性动脉瘤。这4名儿童占1974年至1992年在安大略东部儿童医院所见儿童颅内动脉瘤的33%。创伤性颅内动脉瘤的诊断需要高度的怀疑指数：任何头部受伤或术后的儿童，若出现延迟性神经功能恶化，或治疗后未按预期改善，均应立即进行颅内诊断性成像检查。在此临床背景下，有记录的蛛网膜下腔出血、脑内或脑室内出血或硬膜下血肿，应通过脑血管造影进一步检查，以排除创伤性动脉瘤或其他血管病变。创伤性动脉瘤通常起源于颅底，或因直接壁层损伤或加速引起的剪切力而起源于大脑前动脉或中动脉远端或其分支。报告的创伤性动脉瘤占所有儿童动脉瘤的14% - 39%。医源性动脉瘤在儿童和青少年时期也有意外的高发率。儿童创伤性脑动脉瘤可早期或晚期出现。大多数早期表现为颅内出血。晚期表现较少见，通常为动脉瘤肿块。一旦确诊，这些动脉瘤应立即采用常规显微外科技术进行开颅手术治疗，在某些情况下，也可采用血管内可脱性球囊技术治疗。手术治疗延迟会带来反复出血和死亡的重大风险。这些儿童的预后主要取决于创伤性脑损伤的程度和术前临床状况。后者直接取决于在初次或反复出血之前对动脉瘤的诊断。
