Li Fangcheng,Li Junliang.Key points and concepts in the diagnosis and treatment of cerebrovascular diseases in children[J].Journal of Clinical Pediatric Surgery,2019,18(09):713-718.[doi:10.3969/j.issn.1671-6353.2019.09.001]
小儿脑血管疾病的诊断要点及外科治疗理念
- Title:
- Key points and concepts in the diagnosis and treatment of cerebrovascular diseases in children
- Keywords:
- Cerebrovascular Diseases; Diagnosis; Therapy; Child
- 分类号:
- R726;R743
- 摘要:
- 小儿脑血管疾病临床上并不罕见，随着影像学诊断技术的发展和普及，小儿脑血管疾病的检出率有逐渐升高的趋势。小儿脑血管疾病诊断和治疗过程中明显不同于成人的地方在于循证依据的数量和等级均不够理想，而脑血管疾病的诊疗技术（尤其是血管内治疗技术）近年来发展迅速，因此，不断更新小儿脑血管疾病的诊治理念很有必要。多数小儿脑血管疾病属于外科治疗范畴，在多学科会诊模式下，接受合理诊治的患儿大多具有良好的预后。
- Abstract:
- Pediatric cerebrovascular diseases are not rare.With the development and popularization of imaging diagnostic techniques,the detection rate of cerebral vascular diseases has spiked in children.The clinical characteristics of pediatric cerebrovascular disease are different from those of adults so that there are serious diagnostic and therapeutic delays.Most treatment strategies are non-standard and not evidence-based.However,the diagnostic and therapeutic modalities of cerebrovascular disease,especially endovascular technique,has developed rapidly in recent years.Therefore it is necessary to constantly update the understandings and concepts of pediatric cerebrovascular disease.A great majority of children with cerebrovascular disease belong to the category of surgery and reasonable diagnosis and treatment under a multidisciplinary consultation mode yield a decent prognosis.
参考文献/References:
1 Ferriero DM,Fullerton HJ,Bernard TJ,et al.Management of stroke in neonates and children:a scientific statement from the american heart association/american stroke association[J].Stroke,2019,50(3):e51-e96.DOI:10.1161/STR.0000000000000183.
2 Lehman LL,Khoury JC,Taylor JM,et al.Pediatric stroke rates over 17 years:report from a population-based study[J].J Child Neurol,2018,33(7):463-467.DOI:10.1177/0883073818767039.
3 Krishnamurthi RV,deVeber G,Feigin VL,et al.Stroke prevalence,mortality and disability-adjusted life years in children and youth aged 0-19 years:data from the Global and Regional Burden of Stroke 2013[J].Neuroepidemiology,2015,45(3):177-189.DOI:10.1159/000441087.
4 Chung Brian,Wong Virginia.Pediatric stroke among Hong Kong Chinese subjects[J].Pediatrics,2004,114(2):e206-e212.DOI:10.1542/peds.114.2.e206.
5 Lehman LL,Beaute J,Kapur K,et al.Workup for perinatal stroke:does not predict recurrence[J].Stroke,2017,48(8):2078-2083.DOI:10.1161/STROKEAHA.117.017356.
6 Mallick AA,Ganesan V,Kirkham FJ,et al.Childhood arterial ischaemic stroke incidence,presenting features,and risk factors:a prospective population-based study[J].Lancet Neurology,2014,13(1):35-43.DOI:10.1016/S1474-4422(13)70290-4.
7 Simma B,Martin G,Müller T,et al.Risk factors for pediatric stroke:consequences for therapy and quality of life[J].Pediatr Neurol,2007,37(2):121-126.DOI:10.1016/j.pediatrneurol.2007.04.005.
8 Sultan S,Dowling M,Kirton A,et al.Dyslipidemia in children with arterial ischemic stroke:prevalence and risk factors[J].Pediatr Neurol,2018,78(1):46-54.DOI:10.1016/j.pediatrneurol.2017.09.019.
9 Powers WJ,Rabinstein AA,Ackerson T,et al.2018 Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2018,49(3):e46-e110.DOI:0.1161/STR.0000000000000158.
10 Singh RK,Zecavati N,Singh J,et al.Seizures in acute childhood stroke[J].J Pediatr,2012,160(2):291-296.DOI:10.1016/j.jpeds.2011.07.048.
11 Yock-Corrales A,Barnett P.The role of imaging studies for evaluation of Stroke in Children[J].Pediatr Emerg Care,2011,27(10):966-974.DOI:10.1097/PEC.0b013e318230a002.
12 Lin N,Smith ER,Scott RM,et al.Safety of neuroangiography and embolization in children:complication analysis of 697 consecutive procedures in 394 patients[J].J Neurosurg Pediatr,2015,16(4):432-438.DOI:10.3171/2015.2.PEDS14431.
13 Huang J,McGirt MJ,Gailloud P,et al.Intracranial aneurysms in the pediatric population:Case series and literature review[J].Surg Neurol,2005,63(5):424-432.DOI:10.1016/j.surneu.2004.11.023.
14 Yang M,Wang S,Zhan Y,et al.Management of intracranial aneurysm in children:clipped and coiled[J].Childs Nerv Syst,2008,24(9):1005-1012.DOI:10.1007/s00381-008-0618-4.
15 Orozco M,Trigueros F,Quintana F,et al.Intracranial aneurysms in early childhood[J].Surg Neurol,1978,9(4):247-252.
16 Chen R,Zhang S,You C,et al.Pediatric intracranial aneurysms:changes from previous studies[J].Childs Nerv Syst,2018,34(9):1697-1704.DOI:10.1007/s00381-018-3818-6.
17 Darsaut TE,Guzman R,Marcellus ML,et al.Management of pediatric intracranial arteriovenous malformations:experience with multimodality therapy[J].Neurosurgery,2011,69(3):540-556.DOI:10.1227/NEU.0b013e3182181c00.
18 Gross BA,Storey A,Orbach DB,et al.Microsurgical treatment of arteriovenous malformations in pediatric patients:the Boston Children’s Hospital experience[J].J Neurosurg Pediatr,2015,15(1):71-77.DOI:10.3171/2014.9.PEDS146.
19 Jimenez JE,Gersey ZC,Wagner J,et al.Role of follow-up imaging after resection of brain arteriovenous malformations in pediatric patients:a systematic review of the literature[J].J Neurosurg Pediatr,2017,19(2):149-156.DOI:10.3171/2016.9.PEDS16235.
20 Recinos PF,Rahmathulla G,Pearl M,et al.Vein of Galen malformations:epidemiology,clinical presentations,management[J].Neurosurg Clin N Am,2012,23(1):165-177.DOI:10.1016/j.nec.2011.09.006.
21 Blount JP,Oakes WJ,Tubbs RS,et al.History of surgery for cerebrovascular disease in children.Part Ⅱ.Vein of Galen malformations[J].Neurosurg Focus,2006,20(6):E10.
22 Volpe JJ.Intracranial hemorrhage in early infancy:renewed importance of vitamin K deficiency[J].Pediatr Neurol,2014,50(6):545-546.DOI:10.1016/j.pediatrneurol.2014.02.017.
23 Geng J,Ling Y,Sun Y,et al.Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Circulation,2013,8(3):870-947.
24 Ellis MJ,Amlie-Lefond C,Orbach DB.Endovascular therapy in children with acute ischemic stroke:review and recommendations[J].Neurology,2012,79(suppl 1):S158-S164.DOI:10.1212/WNL.0b013e31826958bf.
25 Goldenberg NA,Bernard TJ,Fullerton HJ,et al.Antithrombotic treatments outcomes,and prognostic factors in acute childhood-onset arterial ischaemic stroke:a multicentre,observational,cohort study[J].Lancet Neurol,2009,8(12):1120-1127.DOI:10.1016/S1474-4422(09)70241-8.
26 Duan L,Bao XY,Yang WZ,et al.Moyamoya disease in China:its clinical features and outcomes[J].Stroke,2012,43(1):56-60.DOI:10.1161/STROKEAHA.111.621300.
27 Scott RM,Smith ER.Moyamoya disease and moyamoya syndrome[J].N Engl J Med,2009,360(12):1226-1237.DOI:10.1056/NEJMra0804622.
28 Macyszyn L,Attiah M,Ma TS.et al.Direct versus indirect revascularization procedures for moyamoya disease:a comparative effectiveness study[J].J Neurosurg,2017,126(5):1523-1529.DOI:10.3171/2015.8.JNS15504.
29 DeVeber G,Andrew M,Adams C,et al.Cerebral sinovenous thrombosis in children[J].N Engl J Med,2001,345(6):417-423.DOI:10.1056/NEJM200108093450604.
30 Mortimer AM,Bradley MD,O’Leary S,et al.Endovascular treatment of children with cerebral venous sinus thrombosis:a case series[J].Pediatr Neurol,2013,49(5):305-312.DOI:10.1016/j.pediatrneurol.2013.07.008.
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备注/Memo
收稿日期:2019-05-26。
通讯作者:李方成,Email:sjwklfc@126.com