Analysis of clinical diagnosis and treatment in children with cerebral vascular malformation / 中国脑血管病杂志

ABSTRACT

Objective To investigate the diagnosis and treatment characteristics in children with cerebral vascular malformation. Methods From September 2007 to December 2016,25 consecutive children with cerebral vascular malformation admitted to the Department of Neurosurgery,the third people′s Hospital of Hainan Province were enrolled retrospectively. The diagnosis was confirmed by CT angiography (CTA) or DSA,including 10 males and 15 females,aged 3-15 years,with a median age of 8 (5,10) years. There were 2 children without hemorrhage and 23 had cerebral hemorrhage. The sites of hemorrhage included frontal lobe in 8 cases,temporal lobe in 5 cases,occipital lobe in 4 cases,and frontal,parietal and temporal lobes in 3 cases,thalamus in basal ganglia in 2 cases,and ventricle in 1 case. The patients were treated with hematoma removal and vascular malformation resection,endovascular embolization,and stereotactic radiotherapy. In the acute phase,15 patients were treated with emergency hematoma evacuation and vascular malformation resection due to intracranial hypertension,and 1 patient was treated with embolization, including 1 craniotomy and 1 external ventricular drainage after embolization. After the subacute phase or when the condition was stable,3 patients underwent surgical resection of vascular malformations and clearance of hematoma,3 received embolization,1 underwent simple hematoma clearance (cerebral venous malformations), and 2 underwent stereotactic radiotherapy. They were followed up at 6 months and 1 year after surgery. The clinical efficacy was evaluated by Glasgow outcome scale ( GOS) score,and CTA and DSA were used to conduct imaging evaluation. Results (1) Twenty-four patients were diagnosed as intracranial arteriovenous malformation,including 9 patients with Sperzler-Martin gradeⅠ,11 with gradeⅡ,and 4 with gradeⅢ. There were 18 patients mainly with anterior circulation blood supply and 6 mainly with posterior circulation blood supply;1 with venous malformation. ( 2 ) No rebleeding occurred during the follow-up, 8 children had seizures,and 1 died at 8 months after operation. The first clinical follow-up was performed in 25 patients at 6 months after treatment. The GOS score was 5 in 5 cases,4 in 12 cases,3 in 4 cases,2 in 3 cases,and 1 in 1 case;they were followed up for more than 1 year. CTA or DSA reexamination showed that 3 children had residual cerebrovascular malformations at 6 months after operation,and the remaining 22 children showed no intracranial vascular malformation. The follow-up time of all the surviving children was >1 year,and DSA was completed at 12 to 38 months after treatment. There was no progress in 3 children with residual vascular malformation during the first follow-up at 6 months after operation and no cerebral hemorrhage occurred. No recurrence was found in 21 children with negative DSA. Conclusions Cerebral vascular malformations in children are mainly arteriovenous malformations,and most them go to see a doctor after spontaneous bleeding. Early diagnosis and reasonable treatment can leave nerve dysfunction as little as possible.