儿童颅内动静脉畸形的显微外科治疗

目的 总结显微手术治疗31例儿童颅内动静脉畸形的经验体会,探讨其治疗方案和手术注意事项.方法 我院自2003年6月～2007年6月对31例儿童颅内动静脉畸形的临床资料、治疗过程以及诊治结果进行回顾性分析.31例中有25例以脑内出血起病,5例以癫痫为主要表现,1例表现为轻度头痛.按照Spetzler-Martin分级,Ⅰ级2例,Ⅱ级12例,Ⅲ级10例,Ⅳ级5例,Ⅴ级2例.单纯手术治疗24例,栓塞后手术7例.结果 31例动静脉畸形团均全切除.6例治疗后出现一过性神经功能缺损或轻度新增神经功能缺损,1例患儿遗留偏瘫.无死亡病例.结论 显微手术切除术可以相对安全有效地治疗儿童颅内动静脉畸形,对于大型或位于功能区的颅内动静脉畸形(AVM),术前栓塞有助于提高疗效.     

儿童Galen静脉畸形2例诊治

Galen静脉畸形是一种主要危及儿童的血管性疾病,临床罕见,约占颅内血管畸形的1%,有较高的致残率和死亡率[1]。随着围产医学及影像诊断和治疗技术的进步,可使本病获得早期发现和及时治疗,从而提高患儿的生存率[1]。本院经影像学检查确诊的2例患儿,现结合文献报道如下。     

儿童脑动静脉畸形的出血危险性及治疗对策

对20例儿童脑动静脉畸形(AVM)进行回顾性研究,探讨脑 AVM大小及引流静脉数与出血危险性的关系以及治疗对策。对比研究发现,脑AVM大小及引流静脉数与出血危险性似有反相关系。提示在儿童脑AVM的治疗中,不但要考虑到儿童的生理特点,也要考虑脑AVM大小及引流静脉数,以便选择最佳治疗方案。     

小儿先天性动静脉瘘的诊治

目的 探讨对小儿先天性动静脉瘘(congenital arteriovenous fistula，CAVF)的诊断与治疗。方法 本组共收治15例CAVF患儿，男6例、女9例，年龄8～14岁。对全部患儿行多普勒超声，动脉造影或MRA检查。发现病变局限者5例，病变范围广泛性者10例，病变大多发生于四肢。动脉造影显示：动静脉之间出现瘘支；动脉分支多而紊乱，可呈碗蜒扭曲状，病变多为弥漫性；静脉象早期出现。对11例患儿行手术治疗，其中4例局限性病变者行病灶切除。对7例病变广泛者行1或多次减量手术，方法是沿动脉主干切除瘘支与病变组织，对分流量大又无法切除的病变组织予以缝扎，以减少分流量。对5例患儿行栓塞治疗(其中2例为术前栓塞治疗以减少手术出血)。1例未治疗。结果 随访1～6年。5例局限性患儿中3例治愈，2例病情控制。10例广泛性病变中，5例病情好转或控制，5例病情仍继续发展。结论 影像学检查是CAVF诊断与治疗的依据。CAVF治疗困难。尤其对广泛性病变者，无论手术或栓塞治疗疗效均欠理想。但对小儿CAVF应尽早治疗，这样可控制病情发展．防止并发症发生。     

立体定向放射治疗儿童动静脉畸形疗效观察

目的　探讨立体定向放射治疗儿童颅内动静脉畸形过程中病灶体积、周边剂量对疗效的影响。方法　设 1～ 2个靶点 ,以包绕 80 %病灶体积的剂量为周边剂量 (15～ 3 0Gy) ,采用西门子直线加速器 6MV -X线进行治疗。分别对比动静脉畸形体积 <4cm3与体积 >4cm3,周边剂量 <2 0Gy与周边剂量～ 2 5Gy、>2 5Gy的疗效。结果　动静脉畸形体积 <4cm3者与体积 >4cm3者相比病灶完全闭塞率高 ,平均闭塞恢复期短 ,并发症少。周边剂量 >2 0Gy较周边剂量 <2 0Gy者病灶的平均恢复期短 ,周边剂量 >2 5Gy者并发症较多。结论　当周边剂量在 15～ 2 5Gy时 ,病灶体积越小 ,完全闭塞率越高 ;病灶体积越小、周边剂量越高 ,平均闭塞恢复期越短 ,但片面追求高周边剂量是不可取的。     

儿童脑血管畸形破裂出血26例

目的 探讨儿童脑血管畸形破裂出血的诊断和治疗。方法 对1990—2001年收治的26例脑血管畸形破裂出血患儿的临床资料进行回顾性分析。结果 脑动静脉畸形(AVM)2l例，海绵状血管瘤5例。经治疗痊愈17例，轻残5例，中残3例，死亡l例。结论 脑血管畸形是儿童自发性颅内出血的主要原因，CT、MRI和脑数字减影血管造影(DSA)检查可辅助诊断，血肿清除加病灶切除是有效的治疗方法。     

先天性肺动静脉瘘的诊治

先天性肺动静脉瘘或称肺动静脉畸形(PAVF)是一种肺内血管畸形，多发生在肺动静脉之间。由于肺动静脉瘘造成肺动脉血液未经毛细血管氧合，致血氧饱和度降低，引起一系列临床症状。如心慌气短、全身无力、紫绀、杵状指(趾)，Hb升高，以至心肺脑功能受损等。迄今文献报道600余例，国内报道手术治疗50余例，     

多发性消化道畸形的诊治体会和教训

患儿 ,女 ,7天 ,第 1胎、第 1产 ,孕 40周胎头吸引助产娩出 ,出生体重 330 0 g,1分钟Apgar评分 1 0分。因频繁呕吐伴发热 ,排鲜血便入院。患儿生后进食 1～ 2小时呕吐 ,反复出现 ,出生后第三天 ,鲜血便三次 ,每次约1 0 ml,体温 38.3℃。给于禁食、输血、补充维生素 ,输液治疗 3天。血便停止 ,体温正常 ,呕吐减轻 ,自动出院。出院后服中药、糖水 ,再次出现频繁呕吐 ,呕吐物有黄绿色胆汁 ,鲜血便多次 ,继之发热 ,无尿、昏睡来我院住院。患儿出生后次日排 3～ 5 g白色便。患儿父亲少年时患脊柱结核 ,现治愈。体检 :体温 39℃ ,心率 1 6 8次 /…     

新生儿消化道畸形的诊治

消化道畸形是新生儿期最常见的畸形之一，国外统计其发生率约为0．25％，国内新生儿科统计大约占同期住院新生儿的0．1％。我院新生儿外科在2003年共收治新生儿外科疾病140例，其中新生儿消化道畸形94例，占67．1％。     

Pulmonary arteriovenous malformations in children: outcomes of transcatheter embolotherapy

OBJECTIVE: To describe outcomes of transcatheter embolotherapy (TCE) in children with pulmonary arteriovenous malformations (PAVMs). STUDY DESIGN: Chart and imaging review of all children (age 相似文献   

Polysplenia with pulmonary arteriovenous malformations

Summary A patient with polysplenia syndrome, dextrocardia, left atrial isomerism, normal great vessel relationships, and no intracardiac shunts developed progressive cyanosis and clubbing. Pulmonary arteriovenous malformations (PAVMs) were diagnosed by angiography and confirmed by lung biopsy. Superior mesenteric arteriogram revealed hypoplasia of the intrahepatic portal vein branches and a portosystemic shunt. The possible etiologies of PAVMs are discussed.     

Intracranial arteriovenous malformation with maternal carbamazepine use

1 1/2 month old child born to primigravida mother on prolonged carbamazepine therapy presented with recurrent seizures. The child had abnormal facies and was diagnosed to be having arteriovenous malformation with intracranial hemorrhage on neuroimaging. This case suggests that development of arteriovenous malformation in a child with maternal carbamazepine therapy may occur as a part of clinical profile of 'fetal anticonvulsant syndrome'.     

Congestive heart failure in neonates due to intracranial arteriovenous malformation: Endovascular treatment

Summary Newborns with intracranial arteriovenous malformations and congestive heart failure have an extremely poor prognosis. This report describes two infants with intracranial arteriovenous malformations and severe congestive heart failure successfully treated in the newborn period with endovascular embolization. Both infants had immediate improvement in symptoms and both had second embolization procedures performed. Ventriculoperitoneal shunting was necessary in both children because of progressive hydrocephalus. At follow-up of more than 4 years, neither patient has any sign of congestive heart failure, and one is developmentally normal.Presented at the meeting, Pediatric Cardiology, Havana, Cuba, November 26–30, 1990.     

Regression of pulmonary arteriovenous malformations following heart transplantation

Pulmonary arteriovenous malformations (PAVMs) can occur following caval to pulmonary artery connection, Glenn and/or Fontan procedure, leading to severe cyanosis and exercise intolerance. It is unknown whether these abnormalities regress or persist following heart transplantation (HTx). Twenty patients with failed Fontan or Glenn procedures were screened for PAVMs prior to HTx by contrast echocardiography, selective pulmonary angiography, and pulmonary venous desaturation. Age at transplant, diagnosis, previous operations, time from Glenn to transplant, systemic oxygenation, hemoglobin level, and ventricular function were determined. The clinical course after HTx was characterized in three patients with significant PAVMs. Indications for HTx were exercise intolerance and severe cyanosis in one patient, and cyanosis and ventricular dysfunction in two. Pre-HTx, mean systemic saturation was 67%; mean pulmonary venous wedge saturation was 81%. Post-HTx, oxygen saturations were normal (> 96%) at 14, 40, and 180 days. Contrast echocardiography, performed 1 month to 3.3 yrs after HTx, showed no intrapulmonary shunting in two patients and minimal shunting in one. One patient suffered an embolic stroke from right-to-left shunting post-HTx. All patients are alive and well 35, 71, and 73 months post-HTx. In patients with single ventricle physiology, PAVMs are not an absolute contraindication to HTx. Heart-lung transplant may not be required for these patients.     

Aortic diastolic pressure decay in congenital arteriovenous malformations

Summary We describe three infants with large congenital arteriovenous malformations, two intracranial and one intrathoracic, who have high output congestive heart failure but normal pulse pressures. The theoretical basis of these pulse pressure findings in contrast to those in infants with shunting secondary to the patent ductus arteriosus is presented.     

Cerebral arteriovenous malformations in childhood: state of the art with special reference to treatment

In this state of the art paper, the clinical and diagnostic features of cerebral arteriovenous malformation (AVM) in childhood are outlined and special attention is paid to the treatment. Several options exists for the treatment of an AVM, consisting of surgery, endovascular embolization, stereotactic radiosurgery, or a combination of these treatments. Received: 19 March 1997 / Accepted: 24 March 1997     

Endovascular treatment of pediatric intracranial arteriovenous shunt

Intracranial arteriovenous shunts (ICAVS) in young children are characterized by frequent high‐flow fistulas. In association with high‐flow fistulas and the physiological condition of the developing brain and heart, each ICAVS type tends to present at a certain age with unique symptoms. Vein of Galen aneurysmal malformation (VGAM) and dural sinus malformation with arteriovenous (AV) shunt tend to present in the neonate with high output cardiac failure. In infancy, VGAM, pial arteriovenous fistula (AVF) and infantile dural AVF (DAVF) tend to present with hydrodynamic disorder such as macrocephaly, ventriculomegaly, prominent facial veins, and developmental delay. Pial AVF, AV malformation, and infantile DAVF can present with focal neurological signs such as seizure or hemorrhage at older ages. Endovascular treatment is currently the first choice of treatment for most pediatric ICAVS. The treatment goal should be defined on a patient‐by‐patient basis, according to the unique physiological condition of the child.