| Background:Spine and spinal cord vascular malformation is often called spinal cord vascular malformation or spinal cord arteriovenous malformation, which accounts for only2-4% of spinal cord related disease but carries a high disability risk [1].Pediatric spinal cord vascular malformation as a special part of the SAVM, which accounts for about6.16%-6.16% of all cases, and it’s considered as a type of congenital diseases associated with embryonic development usually [2, 3]. With the developing of MRI,DSA, microsurgical technology and electrophysiological monitoring technology,SCAVM is diagnosed and treated more easily [4-10].But there are many different clinical characteristics between the pediatric patients(≤14 years old) and the adult patients, such as distribution of the subtype, location of the lesion and the prognosis of treatment. Thus, the difficulty of treatment and the risk of disability are higher in pediatric cases [2, 5, 11].There is only one large group report which included 72 pediatric cases and was made by our center, but the treatment and follow-up result was lack of sufficient analysis and sum up[2].In addition, Gross had summed up the data of pediatric spinal cord vascular malformation which were published in literatures, but the reference value of the result is unsatisfactory because of the vast difference betweenthe treatment level [12, 13]. Therefore, a large cases include pediatric SAVM patients which were treated by one center in recent years is very valuable to guide the treatment.Since 1986, our center have treated more than 2000 SAVM patients(include more than 150 pediatric patients) and accumulated some experience as well. With the developing of endovascular interventional techniques and the intraoperative assistive technology, the treatment and prognosis have changed greatly in recent years.So, we design this study to make up for the defects of the previous reports.Purpose:1. To summarizes the epidemiological characteristics, clinical features, the treatment methods and the follow-up results of the pediatric SAVM cases which were treated in our center in recent 9 years;2. To compare the difference of clinical characteristics between the SAVM and PMAVF, and then, to analyse the factors which influence the treatment and prognosis of pediatric patents.Methods:We retrospectively reviewed 79 consecutive patients with spine and spinal cord vascular malformations who weretreated at the Xuan Wu Hospital between January2007 and December 2013. The study group consisted of 48 boys and 31 grils with a mean age at first presentation of 7.25 years(range, 0-14 years). The clinical features,treatment and follow-up were summarized and analyzed. Then, the data of SAVMs and PMAVFs were compared and analyzed to find out the difference and the factors influencing the treatment and results.The rank sum test was used for the comparison of measurement data between the2 groups and the χ2 goodness-of-fit test was used for the comparison of enumeration data between the 2 groups. Statistical significance was defined as a value of P<0.05.Results:1. Clinical features of 79 cases of spine and spinal cord vascular malformationsThis study consisted of 79 cases with a mean age at first onset of 7.25 years. The SAVM(33/79, 41.77%)and the PMAVF(28/79, 35.44%) was the most common subtypes to be seen in these pediatric patients. Besides, the most common onset type was the sudden onset(74.68%) and the pain was the most common symptoms(49.37%)in this group. The lesions located from the foramen magnum to the sacral canal and the T11-L1 level was the most common location. The patients were treated by embolizations(77.2%),surgeries(10.1%), or a combination of both(12.7%),and after 5-109 months’(average 50.5 months) follow-up, 36.71% of them were cured, 48.10% of them were improved, 11.39% of them were unchanged and 3.80%of them were deteriorated.2. Comparison between the SAVMs and PMAVFsPatients with PMAVFs were younger at onset and presentation and more often presented with motor disturbance than the patients with SAVMs(P<0.05). There were more feeding arteries join the lesions in SAVMs, but, there is no obvious difference between the 2 groups in the incidence rate of dangerous structure and hemorrhage.Complete obliteration could be partly achieved in the SAVMs(63.6%) and PMAVFs(68.4%), and there is no obvious difference. As to the comprehensive therapeutic effect, 53.57% of the PMAVFs can be cured, whereas 51.52% of the SAVMs can be improved only.Conclusions:1. Pediatric spine and spinal cord vascular malformations own its special clinical features compared with the adults and can be achieved good result mostly if received a appropriate treatment timely.2. The pediatric SAVMs and PMAVFs have different clinical Features, which may affect their treatment and long-term prognosis. |
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