背景:小儿自发性颅内夹层动脉瘤(IDA)很少见,但是缺乏比较出血性和缺血性表现的系统研究。这项研究解决了在理解他们的流行病学方面的差距,临床表现,管理,和结果。
方法:对2018年7月至2023年12月期间治疗的23例非创伤性IDA患儿进行回顾性分析。根据表现将患者分为两组:出血性(n=16)和缺血性(n=7)。临床资料进行分析,包括人口统计,放射学发现,治疗方式,和结果。
结果:临床表现各不相同,肢体无力在出血性病例中更为普遍(p=0.014),而头痛和癫痫发作在缺血性病例中更为常见。血管造影分析显示不同的模式,出血病例显示更多远端受累于狭窄和扩张的血管段(珍珠弦征)。同时,缺血组表现为双腔征。各种治疗方法,包括显微外科手术和血管内技术,被利用,观察围手术期并发症,包括一例出血性病例的死亡.多元回归分析确定了围手术期并发症的重要危险因素,即,夹层动脉瘤的构型(p=0.016)和表现类型(p=0.0006)。格拉斯哥的长期结果分数相当,但有出血表现的患者住院时间和ICU住院时间延长(p=0.001).
结论:小儿颅内夹层动脉瘤,尤其是出血性病例,与严重的神经功能缺损和更高的围手术期并发症有关。尽管有类似的长期结果,出血性病例需要长期住院,增加治疗费用。优化儿科ICDAs的管理策略,尤其是那些有出血特征的人,对于改善结果和减少医疗保健支出至关重要。
BACKGROUND: Pediatric spontaneous intracranial dissecting aneurysms are rare, but systematic studies comparing
hemorrhagic and ischemic presentations are lacking. This study addresses gaps in understanding their epidemiology, clinical presentation, management, and outcome.
METHODS: A retrospective analysis of 23 pediatric patients with nontraumatic intracranial dissecting aneurysms treated between July 2018 and December 2023 was conducted. Patients were divided into 2 groups based on presentation:
hemorrhagic (n = 16) and ischemic (n = 7). Clinical data were analyzed, including demographics, radiologic findings, treatment modalities, and outcomes.
RESULTS: Clinical presentations varied, with limb weakness being more prevalent in
hemorrhagic cases (P = 0.014), while headache and seizures were more common in ischemic cases. Angiographic analysis revealed distinct patterns, with
hemorrhagic cases showing more distal involvement on vessel segments with stenosis and dilatation (pearl string sign). At the same time, the ischemic group exhibited the double-lumen sign. Various treatments, including microsurgery and endovascular techniques, were utilized, with perioperative complications observed, including one mortality in a hemorrhagic case. Multiple regression analysis identified significant risk factors for perioperative complications, namely, the configuration of the dissecting aneurysm (P = 0.016) and the type of presentation (P = 0.0006). Long-term Glasgow Outcome Scores were comparable, but patients with hemorrhagic manifestations experienced prolonged hospital and ICU stays (P = 0.001).
CONCLUSIONS: Pediatric intracranial dissecting aneurysms, particularly
hemorrhagic cases, are associated with severe neurologic deficits and higher perioperative complications. Despite similar long-term outcomes, hemorrhagic cases require prolonged hospitalization, increasing treatment costs. Optimizing management strategies for pediatric intracranial dissecting aneurysms, especially those with hemorrhagic features, is essential to improve outcomes and reduce healthcare expenditures.