Gao Wenlong,Yu Zengpeng,Tang Jun,et al.Analysis of vascular structural characteristics in pediatric brain arteriovenous malformations treated with curative embolization: a single-center study[J].Journal of Clinical Pediatric Surgery,2025,(02):114-119.[doi:10.3760/cma.j.cn101785-202410071-003]
单中心治愈性栓塞儿童脑动静脉畸形的血管构筑特征分析
- Title:
- Analysis of vascular structural characteristics in pediatric brain arteriovenous malformations treated with curative embolization: a single-center study
- Keywords:
- Cerebral Arteriovenous Malformation; Endovascular Therapy; Embolization; Therapeutic; Vascular Architectural Features; Child
- 摘要:
- 目的 本研究旨在归纳总结单中心治愈性血管内栓塞治疗儿童脑动静脉畸形(cerebral arteriovenous malformation,cAVM)的血管构筑特征。方法 回顾性分析重庆医科大学附属儿童医院神经外科于2018年9月至2023年8月期间诊治的36例治愈性栓塞cAVM患儿临床资料,并与同期诊治的81例非治愈性栓塞患儿临床资料进行对比,总结分析获得治愈性栓塞患儿的临床表现、影像学特征、血管构筑特征以及手术相关资料。结果 36例获得治愈性栓塞的cAVM患儿中,男26例、女10例;发病年龄最小4个月,最大15岁;畸形团以幕上(28/36,77.8%)、小型(23/36,63.9%)、浅部(23/36,63.9%)、非功能区(27/36,75.0%)为主;供血动脉以浅动脉(29/36,80.5%)、单支供血(27/36,75.0%)和无扩张及狭窄结构异常(28/36,77.8%)为主;静脉引流以浅静脉(26/36,72.2%)、单支引流(31/36,86.1%)和无扩张及狭窄结构异常(30/36,83.3%)为主;Spetzler-Martin(SM)分级Ⅰ级18例,Ⅱ级14例,Ⅲ级4例;2例(2/36,5.6%)发生出血性并发症,1例(1/36,2.8%)发生缺血性并发症;出院时改良Rankin量表(modified Rankin Scale,mRS)评分为0~2分34例(34/36,94.4%),≥3分2例(2/36,5.6%);出院后平均随访35.5个月,末次随访时mRS评分为0~2分35例(35/36,97.2%),≥3分1例(11/36,2.8%)。治愈性栓塞与非治愈性栓塞患儿在cAVM大小(χ2=7.571,P=0.014)及病变部位深浅(χ2=4.263,P=0.039)上比较,差异有统计学意义;在病变部位为幕上或幕上(χ2=0.183,P=0.668)、功能区或非功能区(χ2=0.145,P=0.704)上比较,差异无统计学意义。结论 治愈性栓塞治疗儿童cAVM预后较好。SM分级较低,且血管构筑较简单的患儿容易实现治愈性栓塞。
- Abstract:
- Objective This study aims to summarize the vascular features associated with the curative endovascular embolization treatment of pediatric cerebral arteriovenous malformations (cAVM) in a single-center setting. Methods A retrospective collection of clinical data from 36 pediatric cAVM patients who underwent curative embolization treatment at the Department of Neurosurgery,Children’s Hospital of Chongqing Medical University,between September 2018 and August 2023 was performed.These were compared with clinical data from 81 non-curative embolization cases treated during the same period.The clinical manifestations,imaging characteristics,vascular features,and surgical data of the curative embolization group were analyzed. Results Among the 36 pediatric cAVM patients who underwent curative embolization,26 were male and 10 were female.The age of onset ranged from 4 months to 15 years.The AVM nidus was primarily located supratentorial (28/36,77.8%),small-sized (23/36,63.9%),superficial (23/36,63.9%),and in non-functional areas (27/36,75.0%).The feeding arteries were mostly superficial arteries (29/36,80.5%),single-feed (27/36,75.0%),and showed no signs of dilation or stenotic structural abnormalities (28/36,77.8%).Venous drainage was predominantly superficial veins (26/36,72.2%),single-drainage (31/36,86.1%),and no dilation or stenotic structural abnormalities (30/36,83.3%).The Spetzler-Martin (SM) grades were Ⅰ in 18 cases,Ⅱ in 14 cases,and Ⅲ in 4 cases.Two patients (2/36,5.6%) experienced hemorrhagic complications,and one patient (1/36,2.8%) had ischemic complications.At discharge,the modified Rankin scale (mRS) scores were 0-2 in 34 cases (34/36,94.4%),and ≥3 in 2 cases (2/36,5.6%).The average follow-up duration was 35.5 months,and at the final follow-up,35 patients (35/36,97.2%) had an mRS score of 0-2,while 1 patient (1/36,2.8%) had an mRS score of ≥3.A significant difference was observed between the curative and non-curative embolization groups regarding the size of the cAVM (χ2=7.571,P=0.014) and the depth of the lesion (χ2=4.263,P=0.039).However,no significant difference was found in the location of the lesion (supratentorial vs.infratentorial) (χ2=0.183,P=0.668) or functional vs.non-functional areas (χ2=0.145,P=0.704). Conclusions Curative embolization treatment yields favorable outcomes for pediatric cAVM patients.Children with lower SM grades and simpler vascular structures are more likely to achieve successful curative embolization.
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备注/Memo
收稿日期:2024-10-31。
基金项目:重庆市科卫联合医学项目(2023MSXM136)
通讯作者:梁平,Email:liangping868@sina.com