儿童出血型烟雾病的损伤模式

摘要/Abstract

摘要：

【摘要】目的分析儿童出血型烟雾病的损伤模式。方法回顾性分析中国人民解放军第307医院2002年12月～2011年12月收治的26例出血型烟雾病患儿，根据出血部位发生丘脑出血2例，非丘脑性脑实质出血（基底节和脑叶）3例，脑室出血21例。按照改良的Morioka分级对所有患者的脑血管造影的出血侧脉络膜前动脉和后交通动脉（anterior choroidal artery and posterior communicating artery，AChA-PComA）进行分级，并分析出血病灶分布模式与出血侧AChA-PComA分级及脉络膜后动脉分级的关系。结果所有患儿均发生1次出血。4例患儿合并动脉瘤，其中1例为大脑前动脉瘤，1例为脉络膜前动脉瘤，2例为脉络膜后动脉瘤；所对应出血类型均为脑室出血。AChA-PComA正常或轻度扩张阶段，非丘脑性脑实质出血比例最大（2/3，66.7%），脉络膜后动脉均未显影；AChA-PComA极度扩张和延长阶段，脑室出血所占比例最大（16/17，94.1%）（P＜0.05），脉络膜后动脉均未显影；AChA-PComA未显影阶段，脑室出血比例仍最大（4/6，66.7%），其次为丘脑出血（2/6，33.3%），脉络膜后动脉均表现为极度扩张和延长（P＜0.05）。结论儿童出血型烟雾病中出血类型主要为脑室出血；脑室出血患者相对其他出血类型AChA-PComA极度扩张和延长所占比例高；当颈内动脉在后交通动脉闭塞时即AChA-PComA未显影阶段，脉络膜后动脉均表现为扩张和延长。

文章导读： 本研究系统回顾分析了儿童出血型烟雾病的临床、影像学特征以及可能的损伤模式。

关键词: 儿童; 烟雾病; 脑出血; 血管造影术

Abstract:

【Abstract】 Objective To analyze the lesion patterns of hemorrhagic type of moyamoya disease in children. Methods The clinical and imaging data of 26 hemorrhagic type patients among 450 pediatric patients with moyamoya disease from December 2002 to December 2011 were analyzed retrospectively. According the location of hemorrhage, moyamoya disease patients were classified into three types, thalamic in 2 patients, non-thalamic parenchymal (basal ganglia and cerebral lobe) in 3 patients, primary ventricular hemorrhage in 21 patients. All patients received digital silhouette angiography (DSA). The ipsilateral anterior choroidal artery and posterior communicating artery (AChA-PComA) were evaluated by the modified Morioka's 3-points grading system. The distribution of lesion patterns and the relationship with AChA-PComA and posterior choroidal artery (PChA) were analyzed. Results All the patients suffered one episode of bleeding. A total of 4 patients complicated with aneurysms, 1 was located in the anterior cerebral artery, 1 in the anterior choroidal artery, 2 in the PChA. In the stage of normal or mild dilation, the non-thalamic parenchymal type was the most frequent type (2/3, 66.7%), the PChA were all in stage 1; in the stage of severe dilation with abnormal extension, intraventricular hemorrhage was most common (16/17, 94.1%), the PChA were all in stage 1; in the stage of non-visualization, intraventricular hemorrhage was still the most common type (4/6, 66.7%), others were found in thalamus (2/6, 33.3%). The PChA all manifested dilation and branch extension (P<0.05). Conclusion Intraventricular hemorrhage was the most common type in pediatric hemorrhagic moyamoya patients; compared with other lesion patterns, the dilation and branch extension of AChA-PComA accounted for a large proportion; in the stage of non-visualization of AChA-PComA, PChA all showed dilation and branch extension.

Key words: Children; Moyamoya disease; Hemorrhage; Cerebral angiography

刘鹏，暴向阳，韩聪，李德生，咸鹏，杨伟中，宗睿，张正善，段炼. 儿童出血型烟雾病的损伤模式[J]. 中国卒中杂志, 2013, 8(07): 527-.

LIU Peng, BAO Xiang-Yang, HAN Cong, LI De-Sheng, XIAN Peng, YANG Wei-Zhong, ZONG Rui, ZHANG Zheng-Shan, DUAN Lian.. Lesion Patterns of Hemorrhagic Type of Moyamoya Disease in Children[J]. Chinese Journal of Stroke, 2013, 8(07): 527-.

参考文献

Suzuki J, Takaku A. Cerebrovascular "moyamoya" disease. Disease showing abnormal net-like vessels in base of brain[J]. Arch Neurol, 1969, 20:288-299.

Fukui M. Guidelines for the diagnosis and treatment of spontaneous occlusion of the circle of Willis ('Moyamoya' disease)[J]. Clin Neurol Neurosurg, 1997, 99:S238-S240.

Duan L, Bao XY, Yang WZ, et al. Moyamoya disease in China:Its clinical features and outcomes[J]. Stroke, 2012, 43:56-60.

Morioka M, Hamada J, Kawano T, et al. Angiographic dilatation and branch extension of the anterior choroidal and posterior communicating arteries are predictors of hemorrhage in adult moyamoya patients[J]. Stroke, 2003, 34:90-95.

段炼, 咸鹏, 杨伟中, 等. 硬膜动脉血管融通术治疗儿童烟雾病[J]. 中国临床神经外科杂志, 2009, 14:4-7.

Ahn JH, Wang KC, Phi JH, et al. Hemorrhagic moyamoya disease in children:clinical features and surgical outcome[J]. Childs Nerv Syst, 2012, 28:237-245.

Mugikura S, Takahashi S, Higano S, et al. The relationship between cerebral infarction and angiographic characteristics in childhood moyamoya disease[J]. AJNR Am J Neuroradiol, 1999, 20:336-343.

Fukui M. Current state of study on moyamoya disease in Japan[J]. Surg Neurol, 1997, 47:138-143.

Suzuki J, Kodama N. Moyamoya disease--a review[J]. Stroke, 1983, 14:104-109.

Scott RM, Smith JL, Robertson RL, et al. Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis[J]. J Neurosurg, 2004, 100:142-149.

Ikezaki K, Han DH, Kawano T, et al. Epidemiological survey of moyamoya disease in Korea[J]. Clin Neurol Neurosurg, 1997, 99:S6-10.

Borota L, Bajic R, Marinkovic S, et al. The main epidemiological, clinical and morphological features of moyamoya disease in Yugoslavia[J]. Clin Neurol Neurosurg, 1997, 99:S49-S53.

Chiu D, Shedden P, Bratina P, et al. Clinical features of moyamoya disease in the United States[J]. Stroke, 1998, 29:1347-51.

Graham JF, Matoba A. A survey of moyamoya disease in Hawaii[J]. Clin Neurol Neurosurg, 1997, 99:S31-S35.

Han DH, Kwon OK, Byun BJ, et al. A co-operative study:Clinical characteristics of 334 Korean patients with moyamoya disease treated at neurosurgical institutes (1976-1994). The Korean Society for Cerebrovascular Disease[J]. Acta Neurochir (Wien), 2000, 142:1263-1273.

Hung CC, Tu YK, Su CF, et al. Epidemiological study of moyamoya disease in Taiwan[J]. Clin Neurol Neurosurg, 1997, 99:S23-S25.

Yoshida Y, Yoshimoto T, Shirane R, et al. Clinical course, surgical management, and long-term outcome of moyamoya patients with rebleeding after an episode of intracerebral hemorrhage:An extensive follow-up study[J]. Stroke, 1999, 30:2272-2276.

Saeki N, Nakazaki S, Kubota M, et al. Hemorrhagic type moyamoya disease[J]. Clin Neurol Neurosurg, 1997, 99:S196-S201.

Kobayashi E, Saeki N, Oishi H, et al. Long-term natural history of hemorrhagic moyamoya disease in 42 patients[J]. J Neurosurg, 2000, 93:976-980.

Rafay MF, Smith SE, Dirks P, et al. Hemorrhagic predisposing to cerebral infarction in children with moyamoya disease[J]. Pediatr Neurol, 2006, 34:400-404.

Suyama K, Yoshida K, Takahata H, et al. Pediatric moyamoya disease presenting with intracerebral hemorrhage--report of three cases and review of the literature[J]. Clin Neurol Neurosurg, 2008, 110:270-275.

Iwama T, Morimoto M, Hashimoto N, et al. Mechanism of intracranial rebleeding in moyamoya disease[J]. Clin Neurol Neurosurg, 1997, 99:S187-S190.

史万超, 段炼, 杨日淼, 等. 脑硬膜颞浅动脉血管融通术或联合血管内栓塞治疗烟雾病合并动脉瘤患者的疗效[J]. 中国脑血管病杂志, 2011, 08:626-631.

Ryan RW, Chowdhary A, Britz GW. Hemorrhage and risk of further hemorrhagic strokes following cerebral revascularization in Moyamoya disease:A review of the literature[J]. Surg Neurol Int, 2012, 3:72.

赵云辉, 马著彬, 张玉忠, 等. 数字减影血管造影对烟雾病侧支循环途径的评价[J]. 陕西医学杂志, 2002, 31:291-293.

高山. 烟雾病的血管造影改变和分期[J]. 中国卒中杂志, 2008, 3:505-508.

刘文华, 岳炫烨, 王笑亮, 等. 出血型烟雾病患者72例的损伤模式[J]. 中华神经科杂志, 2011, 44:34-37.

Liu W, Zhu SG, Liu XF, et al. Evaluation of angiographic changes of the anterior choroidal and posterior communicating arteries for predicting cerebrovascular lesions in adult moyamoya disease[J]. J Clin Neurosci, 2011, 18:374-378.

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