Hara H, Burrows P E, Flodmark O, Terbrugge K, Humphreys R
Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont., Canada.
Pediatr Neurosurg. 1994;20(2):126-36. doi: 10.1159/000120775.
The purpose of this report is to determine the role of various imaging modalities, and the outcome of early intervention in neonates with high flow pial arteriovenous malformations (AVM). This report describes 4 neonates with pial AVM associated with congestive cardiac failure, and reviews previous reports. Among the 4 infants in our series, 3 underwent early surgical resection of the AVM, complete in 2 and partial in 1. One infant suffered hemorrhagic infarction postoperatively and has a mild deficit on clinical follow-up; the other 2 patients had no worsening of mild neurologic deficits after surgery, and subsequent development has been normal. The fourth infant had absent deep venous drainage and died from intracranial hemorrhage following transvenous embolization. A single vessel arteriogram in 1 infant led to underestimation of the lesion and unexpected findings at surgery. Complete angiographic study is important in planning treatment, as the vascular anatomy of the lesions may be complex. Cranial ultrasound is useful in early diagnosis, but may miss the superficial lesions. Untreated infants with pial AVM have a poor prognosis due to cardiac failure or progressive cerebral ischemia and neurologic regression. This series illustrates the benefits of complete angiographic investigation and early treatment.
本报告的目的是确定各种成像方式的作用，以及早期干预对患有高流量软脑膜动静脉畸形（AVM）新生儿的效果。本报告描述了4例伴有充血性心力衰竭的软脑膜AVM新生儿，并回顾了既往报告。在我们系列研究的4例婴儿中，3例接受了AVM早期手术切除，2例完全切除，1例部分切除。1例婴儿术后发生出血性梗死，临床随访有轻度功能缺损；另外2例患者术后轻度神经功能缺损未加重，随后发育正常。第4例婴儿深部静脉引流缺失，经静脉栓塞后死于颅内出血。1例婴儿的单血管动脉造影导致对病变估计不足，手术时有意外发现。完整的血管造影研究对治疗规划很重要，因为病变的血管解剖结构可能很复杂。头颅超声有助于早期诊断，但可能遗漏浅表病变。未经治疗的软脑膜AVM婴儿因心力衰竭或进行性脑缺血及神经功能衰退预后较差。本系列研究说明了完整血管造影检查和早期治疗的益处。
