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INC美国William T.Couldwell教授:关于儿童脑动静脉畸形的临床研究

编辑:INC|发布时间:2020-08-03 13:46|点击次数:
Abstract Objective: Large experiences with the treatment of pediatric arteriovenous malformations(AVMs)remain relatively rare,with limited data on presentation,treatment,and long-term functional outcomes.Because of the expected long lifespa...

  Abstract

  Objective:

  Large experiences with the treatment of pediatric arteriovenous malformations(AVMs)remain relatively rare,with limited data on presentation,treatment,and long-term functional outcomes.Because of the expected long lifespan of children,caregivers are especially interested in outcome measures that assess quality of life.The authors'intention was to describe the long-term functional outcomes of pediatric patients who undergo AVM surgery and to identify predictors of sustained neurological deficits.

  Methods:

  The authors analyzed a 21-year retrospective cohort of pediatric patients with intracranial AVMs treated with microsurgery at two institutions.The primary outcome was a persistent neurological deficit at last follow-up.Secondary outcome measures included modified Rankin Scale(mRS)score and independent living.

  Results:

  Overall,97 patients(mean age 11.1±4.5 years;56%female)were treated surgically for intracranial AVMs(mean follow-up 77.5 months).Sixty-four patients(66%)presented with hemorrhage,and 45 patients(46%)had neurological deficits at presentation.Radiologically,39%of lesions were Spetzler-Martin grade II.Thirty-seven patients(38%)with persistent neurological deficits at last follow-up were compared with those without deficits;there were no differences in patient age,presenting Glasgow Coma Scale score,AVM size,surgical blood loss,or duration of follow-up.Multivariate analysis demonstrated that a focal neurological deficit on presentation,AVM size>3 cm,and lesions in eloquent cortex were independent predictors of persistent neurological deficits at long-term follow-up.Overall,92%of the children had an mRS score≤2 on long-term follow-up.

  Conclusions:

  Pediatric patients with AVMs treated with microsurgical resection have good functional and radiological outcomes,particularly when perioperative angiograms are used to confirm obliteration.We identified 3 presentation characteristics that were independently associated with persistent FNDs on long-term assessment after surgical treatment for cerebral AVMs in children:FND on initial presentation,AVM size>3 cm,and AVM location in the eloquent cortex.This information can be useful in counseling of children and families on potential long-term neurological deficit in the setting of cerebral AVM surgery.There is a high rate(38%)of persistent neurological deficits,which were independently predicted by preoperative deficits,AVMs>3 cm,and lesions located in eloquent cortex.This information can be useful in counseling families on the likelihood of long-term neurological deficits after cerebral AVM surgery.Future study comparing long-term outcomes,both cognitive and neurological,across treatment modalities is needed.

脑血管瘤

  中文摘要

  目的:儿童动静脉畸形(AVMs)的治疗经验相对较少,关于其表现、治疗和长期功能结果的资料有限。由于儿童预期寿命较长,照料者对评估生活质量的结果指标特别感兴趣。作者的目的是描述接受AVM手术的儿童患者的长期功能结果,并确定持续神经功能缺损的预测因素。

  方法:作者回顾性分析了两所医院接受显微外科手术治疗的21名儿童颅内动静脉畸形患者。主要结果是在最后的随访中出现持续的神经功能缺损。次要观察指标包括改良Rankin量表(mRS)评分和独立生活。

  结果:97例患者(平均年龄11.1±4.5岁,56%女性)接受了颅内动静脉畸形手术治疗(平均随访77.5个月)。64名患者(66%)出现出血,45名患者(46%)出现神经功能缺损。放射学检查,39%的病灶为Spetzler-Martin二级病变。最后一次随访时有持续性神经功能缺损的37例患者(38%)与无神经功能缺损的患者进行了比较;患者年龄、格拉斯哥昏迷评分、动静脉畸形大小、手术失血量或随访时间无差异。多变量分析显示,在长期随访中,局部神经功能缺损、AVM大小>3cm和大脑皮质病变是持续性神经功能缺损的独立预测因子。总的来说,92%的儿童在长期随访中的mRS评分≤2分。

  结论:经显微外科切除术治疗的儿童动静脉畸形患者具有良好的功能和放射学结果,尤其是在围手术期血管造影证实闭塞时。在儿童脑动静脉畸形外科治疗后的长期评估中,我们确定了与持续性FNDs独立相关的3个表现特征:初始表现时的FND、AVM大小>3cm和AVM在脑功能区皮质的位置。这些信息可用于指导儿童和家庭在脑动静脉畸形手术中潜在的长期神经功能缺损。持续性神经功能缺损的发生率很高(38%),这是由术前缺损、AVM>3cm和位于脑功能区的病变独立预测的。这些信息对于指导家庭了解脑动静脉畸形术后长期神经功能缺损的可能性是有用的。未来的研究需要比较长期的结果,包括认知和神经系统,不同的治疗方式。

  关于美国William T.Couldwell教授

神经外科专家

  •世界神经外科学院(WANS)主席

  •美国神经外科学院主席(2016年-2017年)

  •国际脑膜瘤协会主席(2016年)

  •美国神经外科医师协会(AANS)主席(2013-2014)

  •美国神经外科委员会主任(2006-2012)

  •世界神经外科知名杂志《Neurosurgical Focus》现任主编

  •美国犹他州大学神经外科现任教授和主席

  •美国(America's Top Doctors for Cancer,Castle Connolly,2005-2013)

  •美国(America's Top Doctors,Castle Connolly,2004-2014)

  •美国Patients'Choice Award(2008/2009/2010/2011)

  •美国Compassionate Doctor Award(2010/2011/2014)

  •Charles Balance颅底外科奖,英国颅底外科学会(2018)

世界神经外科知名专家

(美国William T.Couldwell教授在梅菲尔德研讨会的合影,中间为Couldwell教授)

  William T.Couldwell教授擅长领域涵盖脑膜瘤、脑胶质瘤、脑动脉瘤、颅底手术、中风、创伤性脑损伤、头部创伤和神经重症护理等方方面面。尤其擅长脑膜瘤等脑部、颅底、神经肿瘤、垂体肿瘤、癫痫和脑血管神经外科等的外科治疗。主要研究包括颅底肿瘤的外科管理;脑胶质瘤、垂体腺瘤与脑膜瘤中的信号转导与凋亡;多种神经外科疾病如动脉瘤和各种脑瘤的遗传性等。

  在脑膜瘤治疗方面,William T.Couldwell教授拥有海量的脑膜瘤成功手术切除及良好预后病例,对于岩斜区、后颅窝等复杂高难度位置脑膜瘤,他仍能根据患者实际病情和肿瘤大小,熟练应用各种现代化高科技手术设备,采取个性化的手术入路实现极大程度的安全手术切除。

  William T.Couldwell教授作为INC国际神经外科医生集团旗下世界神经外科顾问团(WANG)成员,曾多次来华举办神经外科学术沙龙,也曾为国内疑难神经外科疾病患者开展面对面咨询。INC旗下世界神经外科顾问团(World Advisory Neurosurgical Group,WANG)是由世界各发达国家神经外科宗师联合组成的大师集团,旗下教授大多为其成员教授大多为世界神经外科各专业的奠基者、开拓者,如神经外科领域极高难度的中央颅底手术入路Dolenc入路的发明者、神经外科中颅窝海绵窦知名解剖三角区Dolenc三角区的发现及定义者斯洛文尼亚Vinko V.Dolenc教授;世界神经外科领域知名高难度手术入路Kawase入路的创始发明者,世界神经外科后颅窝知名解剖三角区Kawase三角区发现及定义者日本Takeshi Kawase教授等。他们在各自领域对世界神经外科做出过巨大贡献,且其手术技术和能力在神经外科界有着难以替代的地位。

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