背景:未破裂脑动静脉畸形(URCAVM)的治疗存在很大争议;然而,关于儿童URCAVM的数据很少。
方法:我们回顾性回顾了2001年至2021年在我们部门接受URCAVM随访的连续儿童。
结果:在36例患者中,12个最初是通过观察管理的,24人接受了一线治疗:8人接受了显微外科手术,10放射外科,2通过栓塞,4联合治疗。全组平均随访时间为63个月。治疗组14例(58%)患者畸形完全治愈:显微外科手术组8/8,放射外科组的5/10,联合治疗组的1/4,栓塞组无一例。两名最初未治疗的患者出现脑出血,严重的神经后果。在治疗组中,5例患者出现新的神经功能缺损,只有1个,然而,功能上很重要。11例头痛好转,主要在治疗组。总的来说,治疗组中有6例患者无症状,而观察组没有。
结论:在许多儿科病例中,URCAVM的治疗是一个合理的选择,考虑到儿童一生中脑出血的累积风险,以及URCAVM特有的症状。显微外科,在可行的情况下,提供AVM的最佳功能结果和控制;然而,应根据具体情况权衡风险收益比。需要更多的研究来告知儿科URCAVM的治疗决策。
BACKGROUND: The management of unruptured cerebral arteriovenous malformation (URCAVM) is highly controversial; however, data regarding URCAVM in children are scarce.
METHODS: We retrospectively reviewed consecutive children followed for URCAVM in our department between 2001 and 2021.
RESULTS: Out of 36 patients, 12 were initially managed by observation, and 24 underwent first-line treatment: 8 by microsurgery, 10 by radiosurgery, 2 by embolization, and 4 by combined treatment. Mean follow-up of the whole group was 63months. Complete cure of the malformation was obtained in 14 patients (58%) in the treatment group: 8/8 in the microsurgery group, 5/10 in the radiosurgery group, 1/4 in the combined treatment group, and none in the embolization group. Two of the initially non-treated patients presented cerebral hemorrhage, with significant neurological consequences. In the treatment group, 5 patients presented new neurological deficits, only 1 of which, however, was functionally significant. Headache improved in 11 cases, mostly in the treatment group. Overall, 6 patients in the treatment group became asymptomatic, versus none in the observation group.
CONCLUSIONS: The treatment of URCAVM is a reasonable option in many pediatric cases, considering the cumulative risk of cerebral hemorrhage during the child\'s lifetime, as well as the symptoms specific to URCAVM. Microsurgery, when feasible, offers the best functional results and control of the AVM; however, the risk-benefit ratio should be weighed on a case-by-case basis. More studies will be needed to inform treatment decisions in pediatric URCAVM.