Idiopathic dissecting cerebral aneurysm of the distal anterior cerebral artery in an infant successfully treated with aneurysmectomy: illustrative case

Abstract

BACKGROUNDIdiopathic dissecting cerebral aneurysms (IDCAs) are male dominant but are extremely rare in children. Many IDCAs in children are located in the posterior cerebral artery and the supraclinoid internal cervical artery. No cases of IDCA of the distal anterior cerebral artery (ACA) have been reported.OBSERVATIONSA previously healthy 7-month-old boy experienced afebrile seizures and presented at the authors’ hospital 1 week after the first seizure. He was not feeling well but had no neurological deficits. The authors diagnosed a ruptured aneurysm of the right distal ACA based on imaging results. He underwent emergency craniotomy to prevent re-rupture of the aneurysm. Using intraoperative indocyanine green videoangiography, the authors confirmed peripheral blood flow and then performed aneurysmectomy. Pathological examination of the aneurysm revealed a thickened intima, fragmentation of the internal elastic lamina, and a hematoma in the aneurysmal wall. The authors ultimately diagnosed IDCA because no cause was indicated, including a history of trauma. The boy recovered after surgery and was subsequently discharged with no complications.LESSONSThe authors reported, for the first time, IDCA of the distal ACA in an infant. The trapping technique is often used for giant fusiform aneurysms in infants. Indocyanine green videoangiography is useful for evaluating peripheral blood flow during trapping in this case.

Large saccular intracranial aneurysm in a child with RASA1-associated capillary malformation–arteriovenous malformation syndrome: illustrative case

“…Cerebral aneurysms are much less common in children than in adults; aneurysms in the first two decades of life account for 1%-4% of all intracranial aneurysms. [1][2][3][4][5][6] Although the diagnosis and management may be similar in adults and children, the etiology of cerebral aneurysms in children may require genetic investigation because predisposing conditions can be present, and if so, appropriate management should be pursued. 7 In this report, we present the case of a child with a symptomatic, thrombosed, large saccular aneurysm who was found to have RASA1-associated capillary malformation-arteriovenous malformation (RASA1-CM-AVM) syndrome.…”