Li Junliang,Xu Xinke,Chen Cheng,et al.Diagnosis and treatment of Galen venous aneurysmal malformation: a report of 6 cases[J].Journal of Clinical Pediatric Surgery,2019,18(09):744-747.[doi:10.3969/j.issn.1671-6353.2019.09.007]
Galen静脉动脉瘤样畸形6例诊治及预后分析
- Title:
- Diagnosis and treatment of Galen venous aneurysmal malformation: a report of 6 cases
- 关键词:
- 大脑大静脉动脉瘤样畸形; 血管内栓塞治疗; 预后; 婴儿
- 分类号:
- R726;R743.4;R742.7
- 摘要:
- 目的 探讨Galen静脉动脉瘤样畸形的治疗方法及预后，并总结临床经验。方法 回顾性分析2015年5月至2018年8月广州市妇女儿童医疗中心神经外科收治的6例Galen静脉动脉瘤样畸形患儿的临床资料，6例均接受神经介入栓塞治疗，其中男3例，女3例，年龄3个月至2岁（中位年龄11.8个月），总结该病的临床及影像学特点、治疗方法及随访结果。结果 6例均采用神经介入栓塞治疗，栓塞方式包括单纯球囊辅助弹簧圈、单纯球囊辅助Glubran-2外科胶及弹簧圈结合Glubran-2外科胶三种方式，4例通过1次栓塞治疗后治愈，1例通过2次栓塞治疗后治愈，1例通过2次栓塞治疗后瘘口仍存有少量残留；4例术前合并脑积水者均未行脑脊液分流手术，栓塞术后MRI随访结果显示脑积水均明显缓解，术后4~16个月复查DSA均未复发。结论 Galen静脉动脉瘤样畸形在儿童群体中的发生率可能高于成人，神经介入栓塞治疗安全有效，术后脑积水往往能自行缓解，大多数患儿预后良好。
- Abstract:
- Objective To explore the treatment and prognosis of Galen’s venous aneurysmal malformation and summarize the relevant clinical experiences.Methods The clinical data were retrospectively reviewed for 6 hospitalized children undergoing neurointerventional embolization for Galen venous aneurysmal malformation from May 2015 to August 2018.There were 3 boys and 3 girls with a median age of 11.8 (3-24) months.Their imaging features,treatments and follow-up outcomes were analyzed.Results The embolization methods consisted of simple balloon-assisted coil,simple balloon-assisted Glubran-2 surgical glue embolization and coils plus Glubran-2 surgical glue embolization.Four patients were cured once by embolization.One patient was cured by two embolizations,one patient had minimal fistula after two embolizations and four patients underwent no cerebrospinal fluid shunting preoperatively.During magnetic resonance imaging (MRI) follow-ups,hydrocephalus was significantly relieved after embolization.No recurrence was detected on digital subtraction angiography (DSA) at 4-16 months post-operation.Conclusion The incidence of Galen venous aneurysmal malformation is significantly higher in children than that in adults.Neurological interventional embolization is both safe and effective.Postoperative hydrocephalus often relieves itself.Most patients have a good prognosis.
参考文献/References:
1 Recinos PF,Rahmathulla G,Pearl MA,et al.Vein of galen malformations:epidemiology,clinical presentations,management[J].Neurosurg Clin N Am,2012,23(1):165.DOI:10.1016/j.nec.2011.09.006.
2 Johnston IH,Whittle IR,Besser M,et al.Vein of galen malformation:diagnosis and management[J].Neurosurgery,1987,20(5):747-758.DOI:10.1227/00006123-198705000-00013.
3 Berenstein A,Paramasivam S,Sorscher M,et al.Vein of galen aneurysmal malformation:advances in management and endovascular treatment[J].Neurosurgery,2019,84(2):469-478.DOI:10.1093/neuros/nyy100.
4 Raybaud CA,Strother CM,Hald JK.Aneurysms of the vein of Galen:embryonic considerations and anatomical features relating to the pathogenesis of the malformation[J].Neuroradiology.1989,31(2):109-128.DOI:10.1007/bf00698838.
5 Lasjaunias P,Terbrugge K,Piske R,et al.Dilatation of the vein of Galen.Anatomoclinical forms and endovascular treatment apropos of 14 cases explored and/or treated between [1983] and 1986[J].Neurochirurgie,1987,33(4):315-333.
6 蔡春泉,张庆江,申长虹,等.儿童Galen静脉畸形2例诊治[J].临床小儿外科杂志,2008,7(1):74-75.DOI:10.3969/j.issn.1671-6353.2008.01.029. Cai CQ,Zhang QJ,Shen CH,et al.Diagnosis and treatment of 2 cases of Galen aneurysmal malformation in children[J].Journal of Clinical Pediatric Surgery,2008,7(1):74-75.DOI:10.3969/j.issn.1671-6353.2008.01.029.
7 Donlin M,Long MD,Ph D,et al.Giant arteriovenous malformations of infancy and childhood[J].J Neurosurgery,1974,40(3):304-312.DOI:10.3171/jns.1974.40.3.0304.
8 Heuer GG,Gabel B,Beslow LA,et al.Diagnosis and treatment of vein of Galen aneurysmal malformations[J].Childs Nervous System,2010,26(7):879-887.DOI:10.1007/s00381-009-1063-8.
9 Ergenoglu MA,Yeniel AÖ,Akdemir A,et al.Role of 3D power Doppler sonography in early prenatal diagnosis of Galen vein aneurysm[J].J Turk Ger Gynecol Assoc,2013,14(3):178-181.DOI:10.5152/jtgga.2013.87847.
10 Campi A,Rodesch G,Scotti G,et al.Aneurysmal malformation of the vein of Galen in three patients:clinical and radiological follow-up[J].Neuroradiology,1998,40(12):816-821.DOI:10.1007/s002340050691.
11 Gupta AK,Rao VR,Varma DR,et al.Evaluation,management,and long-term follow up of vein of Galen malformations[J].J Neurosurg,2006,105(1):26-33.DOI:10.3171/jns.2006.105.1.26.
12 Von Halbach V,Dowd CF,Higashida RT,et al.Endovascular treatment of mural-type vein of Galen malformations[J].J Neurosurg,1998,89(1):74-80.DOI:10.3171/jns.1998.89.1.0074.
13 Lasjaunias PL,Chng SM,Sachet M,et al.The management of vein of Galen aneurysmal malformations[J].Neurosurgery,2006,59(5 suppl 3):S184-94.DOI:10.1227/01.NEU.0000237445.39514.16.
14 Alvarez H,Garcia MR,Rodesch G,et al.Vein of galen aneurysmal malformations[J].Neuroimaging Clin N Am,2007,17(2):189-206.DOI:10.1016/j.nic.2007.02.005.
15 Gold A,Ransohoff J,Carter S.Vein of Galen malformation[J].Acta Neurol Scand Suppl,1964,40(1):1-31.
16 Amacher AL,Shillito J.The syndromes and surgical treatment of aneurysms of the great vein of Galen[J].J Neurosurg,1973,39(1):89-98.DOI:10.3171/jns.1973.39.1.0089.
备注/Memo
收稿日期:2019-06-14。
通讯作者:李方成,Email:sjwklfc@126.com