Sun Jingxuan,Zhang RongTing,Yang Yuhao,et al.Traumatic intracranial aneurysms in children: a report of 2 cases with a literature review[J].Journal of Clinical Pediatric Surgery,2025,(02):138-142.[doi:10.3760/cma.j.cn101785-202412041-007]
儿童创伤性颅内动脉瘤2例并文献综述
- Title:
- Traumatic intracranial aneurysms in children: a report of 2 cases with a literature review
- Keywords:
- Traumatic Intracranial Aneurysm; Signs and Symptoms; Diagnosis; Endovascular Therapy; Embolization; Therapeutic; Treatment Outcome; Child; Consensus Development Conference
- 摘要:
- 目的 探讨儿童创伤性颅内动脉瘤(traumatic intracranial aneurysm,TICA)的临床特征及治疗方法。方法 回顾性分析苏州大学附属儿童医院神经外科2020年1月至2023年12月期间收治的TICA患儿临床资料,并检索1993年1月至2023年12月期间PubMed、万方医学网和中国知网儿童TICA相关文献,对发病情况、临床表现、诊治流程进行系统分析。采用改良Rankin量表(modified Rankin Scale,mRS)评估患儿术后末次随访时的临床疗效。结果 本院共收治2例TICA患儿,其中1例为头颅外伤、1例为医源性损伤,2例均伴有不同程度意识障碍,入院后经CT血管造影(computed tomography angiography,CTA)及数字减影血管造影(digital subtraction angiography,DSA)确诊为TICA,均采取介入栓塞治疗,至末次随访时,1例预后良好(mRS评分0~1分),无神经功能障碍残留;1例一侧肢体偏瘫(mRS评分2~3分)。共检索到符合纳排标准文献48篇,其中中文文献6篇、英文文献42篇,涉及病例69例,男41例、女26例;致病原因以交通事故最多(23/69,33.3%);主要临床症状为意识障碍(26/69,37.7%);首次头颅CT主要表现为蛛网膜下腔出血(38/69,55.1%);动脉瘤多位于前循环(48/69,69.6%),以囊状为主(52/69,75.4%),发生破裂人数较多(48/69,69.6%);主要治疗方法为介入治疗(51/69,73.9%);大部分治疗患儿预后良好(45/69,65.2％)。结论 儿童TICA临床少见,症状不典型,需结合病史及辅助检查进行综合判断,治疗以介入方法为主,患儿经治疗后多预后良好。
- Abstract:
- Objective To explore the clinical characteristics and therapeutic approaches for pediatric traumatic intracranial aneurysm (TICA). Methods A retrospective analysis was conducted for the relevant clinical data of TICA children with varying degrees of consciousness disturbance between January 2020 and December 2023.Also a literature review was performed for retrieving the relevant articles on pediatric TICA from PubMed,Wanfang Medical Network and China National Knowledge Infrastructure (CNKI) from January 1993 to December 2023.The incidence,clinical manifestations,diagnostic and therapeutic procedures of TICA were systematically examined.And modified Rankin Scale (mRS) was utilized for assessing the clinical outcomes of children at their last postoperative follow-up. Results The causes were head trauma (n=1) and iatrogenic injury (n=1).Upon admission,TICA was diagnosed via computed tomography angiography (CTA) and digital subtraction angiography (DSA).Interventional embolization therapy was performed.At the last follow-up,1 case exhibited a favorable prognosis (mRS 0-1) with no residual neurological dysfunction while another case developed hemiplegia of one limb (mRS 2-3).Among the retrieved literature,48 articles fulfilled the exclusion criteria,including 6 Chinese and 42 English articles.Among a total of 69 cases,there were 41 boys and 26 girls with a boy-to-girl ratio of 1.6∶1.Traffic accidents were identified as the most common cause (23/69,33.3%) and consciousness disturbance dominated (26/69,37.7%).Subarachnoid hemorrhage was a primary manifestation on initial cranial computed tomography (CT) upon admission (38/69,55.1%).A large majority of aneurysms were located in anterior circulation (48/69,69.6%),largely cystic in nature (52/69,75.4%) and had a high rupture rate (48/69,69.6%).Interventional therapy was the most frequently chosen treatment modality (51/69,73.9%).And most children exhibited a favorable prognosis after treatment (45/69,65.2％). Conclusions Pediatric traumatic aneurysms are infrequent in clinical practices and tend to have atypical symptoms.A comprehensive diagnosis should be made through integrating medical history and auxiliary examinations.
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备注/Memo
收稿日期:2024-12-15。
基金项目:国家自然科学基金(81902972)
通讯作者:杨天权,Email:szdxytq@suda.edu.cn