由于高容量的液体栓塞剂栓塞导致的阻塞性水,用于治疗儿科动脉静脉形:说明案例
Alex Devarajan1, Chi Le2, Tomoyoshi Shigematsu2
1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue; Floor 8, New York, NY, 10029, USA. alex.devarajan@icahn.mssm.edu.
概括
使用大容量液体栓塞剂 (LEA) 的高强度栓塞可能会增加儿童阻塞性脑水症的风险. 在治疗后严密监测新发水头症至关重要.
科学领域:
- 儿童神经外科
- 干预性神经放射学
- 脑血管疾病
背景情况:
- 随着格伦静脉形 (VOGM) 的发展,人们更倾向于采取积极的方法来彻底消灭这种疾病.
- 使用大量液体栓塞剂 (LEA) 的逆行压力技术越来越受欢迎.
- 关于高体积栓塞对儿童大脑发育的影响的数据有限.
研究的目的:
- 在儿科患者中研究高容量液体栓塞剂 (LEA) 栓塞后阻塞性水的潜在风险.
- 强调在积极的VOGM治疗后对新发水脑病进行警的神经外科随访的重要性.
主要方法:
- 一个2岁男孩的病例报告用高容量的LEA (Onyx,n-BCA,线圈) 治疗VOGM.
- 患者患有三室水,并经过栓塞后出现临床恶化.
- 进行了紧急内镜第三腹腔切除术 (ETV),结果良好,没有永久的神经缺陷.
主要成果:
- 患者经历了新出现的阻塞性脑水,
- 透视第三腹腔镜 (ETV) 有效地解决了脑水症.
- 长期随访没有显示永久的神经缺陷和持续的发育进展.
结论:
- 虽然对VOGM的高容量LEA栓塞是有效的,但即使在以前没有水的患者中,也可能会增加阻塞性水的风险.
- 神经外科医生必须保持高水平的怀疑新发水脑病在儿童患者大容量VOGM栓塞后.
- 激进的栓塞策略需要仔细监测潜在的并发症,例如由于质量效应而导致的脑水.
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