Ohno K, Matsushima Y, Toriyama H, Hokari M, Nariai T, Suzuki R, Hirakawa K
Department of Neurosurgery, Tokyo Medical and Dental University, Japan.
Acta Neurochir (Wien). 1996;138(10):1218-22; discussion 1222-3.
Ischaemic cerebral strokes in children are relatively uncommon. With the exception of patients with moyamoya disease, there is no effective treatment for these lesions. One potential approach is encephalo-duro-arterio-synangiosis (EDAS). This is a safe neurosurgical procedure that promotes spontaneous transdural anastomosis that may provide additional blood flow to ischaemic regions. We present eight children with ischaemic strokes other than moyamoya disease, and discuss surgical attempts to treat this entity. The mean age of the eight children was 3.6 years (range: 13 months to 9 years). All children presented with acute childhood hemiplegia. Ischaemic stroke had occurred in association with a head injury in three children, but without an apparent cause in five. Five children underwent stable xenon-enhanced computed tomography to evaluate cerebral blood flow and all but one patient underwent EDAS. One child with no angiographic abnormalities recovered to a normal neurological state without surgery. Following surgery, another child also fully recovered, and the remaining six children recovered with only a slight hemiparesis. Revascularization was observed on a follow-up angiogram in three children. Our surgical experiences suggest that revascularization is influenced by haemodynamic demand and recanalization of the occluded artery. We favour the use of indirect anastomosis (EDAS) for selected patients and suggest that chronic ischaemia probably contributes to surgical success.
儿童缺血性脑卒相对少见。除烟雾病患者外，这些病变尚无有效治疗方法。一种潜在的治疗方法是脑-硬脑膜-动脉-血管吻合术（EDAS）。这是一种安全的神经外科手术，可促进自发性硬膜外吻合，为缺血区域提供额外的血流。我们报告了8例非烟雾病所致缺血性脑卒中患儿，并讨论了治疗该疾病的手术尝试。这8名儿童的平均年龄为3.6岁（范围：13个月至9岁）。所有儿童均表现为急性儿童偏瘫。3名儿童的缺血性脑卒中与头部受伤有关，5名儿童无明显病因。5名儿童接受了稳定的氙增强计算机断层扫描以评估脑血流量，除1名患者外，所有患者均接受了EDAS手术。1名无血管造影异常的儿童未经手术即恢复至正常神经状态。手术后，另一名儿童也完全康复，其余6名儿童仅遗留轻微偏瘫。3名儿童在随访血管造影中观察到血管再通。我们的手术经验表明，血管再通受血流动力学需求和闭塞动脉再通的影响。我们赞成对选定患者采用间接吻合术（EDAS），并认为慢性缺血可能有助于手术成功。
