Dural arteriovenous fistulae in a 6-year-old girl with trisomy 21 and congenital heart disease

IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY
Toshiya Ishikura , Yuri Sonoda , Kenta Kajiwara , Pin Fee Chong , Hikaru Kanemasa , Yoshitomo Motomura , Noriyuki Kaku , Yuichiro Hirata , Hazumu Nagata , Kenichiro Yamamura , Koichi Arimura , Akira Nakamizo , Yasunari Sakai , Shouichi Ohga
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Abstract

Dural arteriovenous fistula (DAVF) represents a pathological group of intracranial shunts arising from the dural artery to venous sinus and veins. Childhood-onset DAVF is generally considered to be poor in prognosis, whereas only limited information is available for the onset and long-term outcomes. We herein report a Japanese girl with trisomy 21, large ventricular septal defects, and pulmonary vein stenosis, for which a transcatheter stent had been placed after birth. At age 6 years, she developed bacterial meningitis due to S. pneumoniae, leading to the diagnosis of venous sinus thrombosis and multiple intracranial shunts. Cerebral angiography identified multiple shunts arising from the middle meningeal arteries to the superior sagittal sinus and a concurrent reflux to cortical vein. Endovascular embolization successfully occluded the shunts without neurovascular complications over 24 months. This report first demonstrates the favorable outcome of DAVF in a pediatric patient with trisomy 21 after the catheter intervention. For children at a risk for intracranial thrombosis, preemptive neurovascular evaluation and transcatheter intervention provide a chance of early diagnosis of DAVF to improve their survival and neurologic outcome.

一名患有 21 三体综合征和先天性心脏病的 6 岁女孩硬膜动静脉瘘
硬膜动静脉瘘(DAVF)是硬膜动脉向静脉窦和静脉分流的一组颅内病理分流。一般认为,儿童期发病的硬脑膜动静脉瘘预后较差,但有关其发病和长期预后的信息却非常有限。我们在此报告了一名患有 21 三体综合征、大室间隔缺损和肺静脉狭窄的日本女孩,她在出生后就被植入了经导管支架。6 岁时,她患上了肺炎双球菌引起的细菌性脑膜炎,从而被诊断为静脉窦血栓和多发性颅内分流。脑血管造影检查发现,从脑膜中动脉到上矢状窦有多处分流,同时还有皮质静脉回流。血管内栓塞术成功堵塞了分流,24 个月内未出现神经血管并发症。该报告首次证明了 21 三体综合征儿科患者在导管介入治疗后 DAVF 的良好疗效。对于有颅内血栓形成风险的儿童,预先进行神经血管评估和经导管介入治疗可为早期诊断 DAVF 提供机会,从而改善他们的生存和神经功能预后。
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来源期刊
Clinical Neurology and Neurosurgery
Clinical Neurology and Neurosurgery 医学-临床神经学
CiteScore
3.70
自引率
5.30%
发文量
358
审稿时长
46 days
期刊介绍: Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.
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