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ABSTRACT: To assess the radiological characteristics and therapeutic strategies of intracranial aneurysms in childhood and adolescence.
From our dedicated aneurysmal patient databank, the investigators reviewed 39 consecutive children and adolescents with 44 intracranial aneurysms. There were 24 boys and 15 girls.
Twenty-two patients underwent endovascular treatment. Among them, 8 patients received microsurgical therapy. Aneurysms became spontaneously thrombosed before therapy in 3 patients. One patient died pre-operatively from a re-rupture of aneurysm. And 5 cases were not treated at all.
Intracranial aneurysms in childhood and adolescence have many clinical and radiological characteristics: (1) remarkable male predominance; (2) middle cerebral artery is the most common site for aneurysms; (3) there is a high prevalence of giant, traumatic, dissecting and fusiform aneurysms; (4) both microsurgical approaches and endovascular treatment were effective. For some giant complex intracranial aneurysms, parent arterial occlusion or EC-IC (extracranial-intracranial) bypass is the best therapeutic choice. A majority of patients may have favorable outcomes.
Zhonghua yi xue za zhi 10/2011; 91(39):2744-6.
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ABSTRACT: The authors conducted a study to assess the clinical pattern, radiological features, therapeutic strategies, and long-term outcomes in patients with intramedullary spinal cord cavernomas (ISCCs) based on a large case series.
This retrospective study identified 96 patients (60 males, 36 females) surgically (81 cases) or conservatively (15 cases) treated for ISCCs between May 1993 and November 2007. Each diagnosis was based on MR imaging and spinal angiography evidence. For all surgically treated patients, the diagnosis was verified pathologically. The neurological outcomes pre- and postoperatively, as well as long-term follow-up, were assessed using the Aminoff-Logue Disability Scale.
The mean age at the onset of symptoms was 34.5 years (range 9-80 years). Of the lesions, 68 (71%) were located in the thoracic spine, 25 (26%) in the cervical spine, and only 3 (3%) in the lumbar spine. The median symptom duration was 19.7 months. The clinical behavior of the lesion was a slow progression in 73 cases and an acute decline in 23 cases. Long-term follow-up data (mean 45.8 months, range 10-183 months) were available for 75 patients (64 surgical cases and 11 conservative cases). In the surgical group, a complete resection was achieved in 60 patients, and incomplete resection was detected in 4 patients after operation. At the end of the follow-up period in the operative group, 23 patients (36%) improved, 35 (55%) remained unchanged, and 6 (9%) worsened. In the nonoperative group, 5 patients improved, 6 patients remained unchanged, and none worsened.
For differential diagnosis, spinal angiography was necessary in some cases. For most symptomatic lesions, complete microsurgical resection of the symptomatic ISCC is safe and prevents rebleeding and further neurological deterioration. However, in patients whose lesions were small and located ventrally in the spinal cord, one can also opt for a rigorous follow-up, considering the high surgical risk.
Journal of neurosurgery. Spine 07/2011; 15(4):447-56. · 1.61 Impact Factor
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ABSTRACT: Intracranial aneurysms are extremely uncommon in adolescents. This study was undertaken to assess the clinical and radiological characteristics and clarify the choice of therapeutic strategies of intracranial aneurysms in adolescents with age range from 15 to 18 years.
From our dedicated aneurysmal databank between October 1985 and July 2008, we reviewed 16 consecutive adolescents who had 20 intracranial aneurysms.
Ten boys and six girls (male/female ratio = 1.67:1; mean age 16.78 ± 1.18 years) were included in the present study. Intracranial aneurysms in adolescents constituted 0.91% of all intracranial aneurysms. It was found that 25% of the lesions were in the posterior circulation, while 75% of the lesions were in the anterior circulation, and 25% developed on the middle cerebral artery (MCA). Half of the patients presented with subarachnoid hemorrhage and others mainly presented with mass effect such as weakness in the extremities, diplopia, and dysfunction of eye movement. Eight cases underwent endovascular treatment: including GDC therapy in five patients, parental artery occlusion in two patients, and cover stent implantation in one patient with pseudoaneurysm of the cavernous segment of the left internal carotid artery. Four patients received microsurgical therapy: aneurismal neck clipping for two patients and extracranial-intracranial (EC-IC) bypass and trapping of complex aneurysms in MCA for the other two patients. Four patients did not receive microsurgical or endovascular therapy, including a boy whose aneurysm spontaneously thrombosed preoperatively and a girl who died before operation because of rerupture of aneurysm. Two patients did not undergo therapy owing to the high operative risk. All of the patients who received therapy had favorable outcome (GOS 4 or 5) at discharge and at follow-up.
Intracranial aneurysms in adolescents differ from those in adults in many ways including the following: male predominance; high incidence of large or giant, traumatic, dissecting, and fusiform aneurysms; high incidence of aneurysms in the posterior circulation; high incidence of spontaneous thrombosis; better Hunt-Hess grade at presentation; and better therapeutic outcome. Both microsurgical approaches and endovascular treatment were effective. For some giant, complex intracranial aneurysms, parent artery occlusion or EC-IC bypass is the best treatment choice.
Child s Nervous System 01/2011; 27(7):1101-7. · 1.54 Impact Factor
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ABSTRACT: Cutaneous vertebral medullary angiomatosis, also known as Cobb's syndrome, is a part of spinal arteriovenous metameric syndromes (SAMs), is derived from the vascular malformation triad of skin, bone, and spinal cord involvement. It is poorly managed with current treatment modalities. We reviewed the treatment of Cobb's syndrome series and summarized the experiences.
A total of 61 cases of Cobb's syndrome with spinal cord dysfunction were treated at our department from February 2003 to December 2007. The treatment followed the same strategy: First step-investigating the pathogenic mechanisms by symptom onset, MRI, angiography and the response to initial treatment. Second step-treating the problematic parts of the lesions with embolization alone, surgery alone or combination of both. Forty-eight cases were embolized, 3 cases treated with surgery and 10 cases treated with a combination of both. Nidus involving pathogenic mechanism for spinal cord were eliminated, completely and nearly disappeared in 36 cases and partially in 25 cases. All patients were followed up regularly.
Among these 61 cases, the pathogenic mechanisms were identified as hemorrhage, mass effect, ischemia and venous hypertensive myelopathy. Two or more mechanisms could coexist in the same patient. More than 1-year's spinal cord function follow-up showed: excellent in 9 cases, good in 26, fair in 23 and worse in 3.
Not all lesions of Cobb's syndrome can be or should be cured anatomically. Pathogenic mechanism should be analyzed carefully and the treatment should focus on the special cord-affecting targets. Long-term improvement or stabilization may be achieved.
Zhonghua yi xue za zhi 04/2010; 90(13):882-5.
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ABSTRACT: To investigate the effects and methods of intracranial-extracranial (IC-EC) bypass surgery in the treatment of intracranial aneurysms.
The clinical material of 9 cases, who performed IC-EC bypass surgery before occlusion of the parental arteries of intracranial aneurysms, was studied retrospectively, especially how to evaluate the co-lateral circulation of the parental arteries and how to select the different methods of IC-EC bypass surgery.
The co-lateral circulation in 9 cases was not enough to meet the need of the cerebral blood flow after occlusion of the parental arteries of the aneurysms. Revascularization by different methods of IC-EC bypass surgery and then occlusion of the parental arteries, ischemia in the brain area feeding by occluded parental arteries of the aneurysms did not occurred.
When the co-lateral circulation of the parental arteries of intracranial aneurysm is not enough, the revascularization by different methods of IC-EC bypass surgery is needed before occlusion of these arteries.
Zhonghua wai ke za zhi [Chinese journal of surgery] 02/2006; 44(2):129-32.
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Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences 12/2005; 34(6):582-4.
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Chinese medical journal 04/2005; 118(5):433-5. · 0.86 Impact Factor
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ABSTRACT: To discuss the diagnosis, treatment and prognosis of spinal dural arteriovenous fistulas (SDAVF).
The clinical and following-up date from 110 patients with SDAVF diagnosed by spinal MRI and spinal angiography were analyzed retrospectively.
Draining vein between fistula and spinal cord was interrupted by laminectomy approach as first choice in 61 patients, by hemi-laminectomy approach in 37, and by endovascular embolization in 12, and re-operation due to recurrence after embolization in 3. Anticoagulation, hydration and early rehabilitation were used postoperatively. Complete disappearance of SDAVF was confirmed in all 106 patients who received postoperative spinal angiography. The para-medullary tortuous flow voids fully disappeared in 74 patients and partly disappeared in 15 on postoperative T(2)-weighted MRI. Follow up of 98 patients showed complete recovery in 54 patients, improvement in 34, and no change in 10. Three of the 10 patients were reoperated on because of recurrence 1 to 5 years after embolization.
SDAVF can produce good outcome after early diagnosis and treatment. Interruption of the draining vein between fistula and spinal cord by hemi-laminectomy approach is the first choice for the treatment of SDAVF.
Zhonghua wai ke za zhi [Chinese journal of surgery] 03/2003; 41(2):99-102.
