Characteristics and Treatment Outcome of Intracranial Aneurysms in Children and Adolescents

Nam, Sun Mo; Jang, Donghwan; Wang, Kyu Chang; Kim, Seung Ki; Lee, Ji Yeoun; Cho, Won Sang; Kim, Jeong Eun; Kang, Hyun Seung

doi:10.3340/jkns.2019.0140

Cited by 16 publications

(19 citation statements)

References 40 publications

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“…In our sample, giant aneurysms were found in ~ 27% of the cases, compatible with the 6-40% found in other series [2,7,8,13,22]. Regarding the location of the aneurysms, the ICA was the most common site (53%), as reported in several series [7,13,15], although some authors found MCA predominance [3,4]. Regarding the morphology, although most aneurysms were saccular and located in the anterior circulation, the rates of fusiform aneurysms (13%) and posterior circulation aneurysms (27%) are similar to literature, and higher when compared with adult series [1,2,3,15].…”

Section: Characteristics In Young-age Patientssupporting

confidence: 91%

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Intracranial Aneurysms in the Pediatric Population: Case Series

Demart

Pardins

Koppe

et al. 2022

Preprint

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Introduction: Aneurysms are rare in the pediatric population and its diagnosis can be challenging. They differ from their adult counterparts in several aspects, and hemorrhage is the most frequent presentation. Objective: To evaluate clinical data, aneurysms characteristics and therapeutic results in a series of patients <18 years of age with intracranial aneurysms. Method: A retrospective cross-sectional observational study design through the analysis of medical records and imaging studies. Analyzed data included age, sex, presentation, comorbidities, aneurysmal characteristics, treatment modality and clinical outcomes. Results: 15 intracranial aneurysms were identified in 11 patients (6 male), with ages ranging from 3 months to 15 years (mean 5.2 years). Five patients had associated medical conditions, and hemorrhage was the most frequent clinical presentation (45%). Three patients (27%) had multiple aneurysms, and 7 aneurysms were fusiform or dysplastic. The internal carotid artery was the most affected site, occurring in 47% of cases. Aneurysm size ranged from 2 mm to 60 mm (mean 16.8 mm), with giant aneurysms in 27%. Seven patients were treated via endovascular procedures and three aneurysms were clipped. Symptomatic vasospasm requiring angioplasty occurred in two patients. One patient died due to severe aspiration pneumonia and sepsis that precluded treatment. Good functional outcome (mRS < 2) was achieved in all patients submitted to treatment (91%). Conclusion: The patients with aneurysms in this series were characterized by hemorrhagic presentation, mild male predominance, and internal carotid artery involvement. The outcome of treated patients was favorable, regardless of the treatment modality.

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Section: Characteristics In Young-age Patientssupporting

confidence: 91%

“…The aneurysms in childhood have a higher proportion of giant, fusiform and posterior circulation aneurysms than in adults [2,7,8,13,15,17]. In our sample, giant aneurysms were found in ~ 27% of the cases, compatible with the 6-40% found in other series [2,7,8,13,22].…”

Section: Characteristics In Young-age Patientssupporting

confidence: 87%

Intracranial Aneurysms in the Pediatric Population: Case Series

Demart

Pardins

Koppe

et al. 2022

Preprint

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“…Regarding locations, the authors reported a higher proportion of posterior circulation [1, 4, 8, 9, 15] and ICA terminus [11, 15] aneurysms in children than in adults [1, 3], as well as dissecting aneurysms [3, 15] and giant lesions [3-5, 7-10]. In this series, 24% of the lesions ( n = 4) were in the posterior circulation, and 18% ( n = 3) in ICA terminus.…”

Section: Discussionmentioning

confidence: 99%

“…Brain aneurysms affect almost exclusively the adult population [1], and its incidence in children is rare [1][2][3][4][5][6][7][8][9][10], accounting for less than 5% of all aneurysms [1-3, 5, 7, 8, 11, 12]. Also, compared to adults, they are more complex [4,10] and differ in location, morphological characteristics, the presentation, and outcome [7,8].…”

Section: Introductionmentioning

confidence: 99%

Intracranial Aneurysm in Pediatric Population: A Single-Center Experience

et al. 2022

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Purpose: Pediatric intracranial aneurysms (PIA) are rarer and more complex when compared to adult aneurysms. In general, the clinical presentation of PIA is due to a mass effect, but the presenting symptoms can be also related to ischemia, subarachnoid hemorrhage (SAH) or in a combination of different symptoms. This paper aims to report a single-center experience with clinical and angiographic aspects of brain aneurysm in children. Methods: We retrospectively reviewed our prospectively maintained database for patients with intracranial aneurysms in our institution from July 2015 to February 2021. Among these, all patients under 18 years-old submitted to a diagnostic or therapeutic procedure for an intracranial aneurysm were included. Results: Twelve patients were submitted to diagnostic or therapeutic procedures in our department. Three of them had multiple aneurysms, and in total, 17 intracranial aneurysms were assessed in this study. The most frequent location was in the middle cerebral artery (seven cases / 41%). Five out of twelve children (42%) presented SAH due to ruptured aneurysm. Three patients (25%) had symptoms due to the mass effect from large aneurysms, with compression of cranial nerves or brainstem. Aneurysms diameters ranged from 1.5 mm to 34 mm (mean 14.2 mm), with six aneurysms being giant and eight being non-saccular/fusiform. Twelve aneurysms were submitted to endovascular treatment, with one treatment-related clinical complication and later death. Conclusion: Pediatric intracranial aneurysms are rare diseases that can arise from a variety of different underlying pathological mechanisms. The management of these conditions requires a detailed understanding of the pathology and a multi-disciplinary approach. Despite the availability of new technologies, parent vessel occlusion remains a valid option for aneurysms in the pediatric population.

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“…1,2 To date, most reports of pediatric aneurysms consist of case reports and small case series. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Most large series in the last 15 years reported on an average of 39 patients. We previously presented a series of 19 patients treated at our institution from 1991 to 2004 over the course of 13 years.…”

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confidence: 99%

Epidemiology and outcomes of pediatric intracranial aneurysms: comparison with an adult population in a 30-year, prospective database

Xie

Yang

et al. 2021

Journal of Neurosurgery: Pediatrics

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OBJECTIVE Pediatric intracranial aneurysms are rare. Most large series in the last 15 years reported on an average of only 39 patients. The authors sought to report their institutional experience with pediatric intracranial aneurysms from 1991 to 2021 and to compare pediatric patient and aneurysm characteristics with those of a contemporaneous adult cohort. METHODS Pediatric (≤ 18 years of age) and adult patients with one or more intracranial aneurysms were identified in a prospective database. Standard epidemiological features and outcomes of each pediatric patient were retrospectively recorded. These results were compared with those of adult aneurysm patients managed at a single institution over the same time period. RESULTS From a total of 4500 patients with 5150 intracranial aneurysms admitted over 30 years, there were 47 children with 53 aneurysms and 4453 adults with 5097 aneurysms; 53.2% of children and 36.4% of adults presented with a subarachnoid hemorrhage (SAH). Pediatric aneurysms were significantly more common in males, more likely giant (≥ 25 mm), and most frequently located in the middle cerebral artery. Overall, 85.1% of the pediatric patients had a modified Rankin Scale score ≤ 2 at the last follow-up (with a mean follow-up of 65.9 months), and the pediatric mortality rate was 10.6%; all 5 patients who died had an SAH. The recurrence rate of treated aneurysms was 6.7% (1/15) in the endovascular group but 0% (0/31) in the microsurgical group. No de novo aneurysms occurred in children (mean follow-up 5.5 years). CONCLUSIONS Pediatric intracranial aneurysms are significantly different from adult aneurysms in terms of sex, presentation, location, size, and outcomes. Future prospective studies will better characterize long-term aneurysm recurrence, rebleeds, and de novo aneurysm occurrences. The authors currently favor microsurgical over endovascular treatment for pediatric aneurysms.

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Characteristics and Treatment Outcome of Intracranial Aneurysms in Children and Adolescents

Cited by 16 publications

References 40 publications

Intracranial Aneurysms in the Pediatric Population: Case Series

Intracranial Aneurysms in the Pediatric Population: Case Series

Intracranial Aneurysm in Pediatric Population: A Single-Center Experience

Epidemiology and outcomes of pediatric intracranial aneurysms: comparison with an adult population in a 30-year, prospective database

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