Intracranial arterial aneurysms in children and adolescents

Abstract

Throughout the period 1943 to 1980, 1368 patients with verified intracranial saccular aneurysms were treated in the University of Aarhus neurosurgical department. Forty-three (3.1%) patients (25 boys and 18 girls) were 19 years old or younger, and 33 (77%) had an onset of symptoms typical of subarachnoid bleeding. Using the classification system of Hunt and Hess as a basis for clinical assessment on admission, 58% of the patients could be placed in Grade I or II. Cerebral vasospasm was demonstrated in 53% of the patients undergoing angiography between the 4th and 16th day after hemorrhage. There was no increased morbidity or mortality in the group of patients with vasospasm, and no cerebral infarction was demonstrated at necropsy. Therefore, it is possible that vasospasm is of minor prognostic significance in children. In 15 patients (37%), aneurysm rupture was accompanied by intracerebral hematoma. The mortality rate in this group of 15 patients was 50%, whereas in the group without hematoma it was 26%. The overall mortality rate was 33%. The surviving 29 patients were followed for 3 months to 14 years. Twenty-three patients made a good recovery (80% of survivors and 54% of the total series), five were moderately disabled, and one was severely disabled.

Aneurisma intracraniano gigante em criança de nove anos: relato de caso

“…Entretanto na casuística apresentada por Ostergaard e Voldby", apenas 4,6% dos casos eram considerados aneurismas gigantes. Podem ser múltiplos em 9,2 a 11% dos casos 5,11 . Consideram-se aneurismas gigantes aqueles cuja medida ultrapassa 25 mm 2,9,1U7,19 .…”

“…Com relação à segunda corrente fisiopatológica, seus defensores baseiam-se em casos envolvendo recém-natos 12 , explicando por displasia arterial, como acontece na deficiência de colágeno tipo III, ocasionalmente detectada 81014 . Da mesma forma, casos de aneurismas com incidência familial ou associados a outras malformações, como coarctação da aorta, estenose aórtica ou rins policísticos, explicariam a formação de aneurismas 11 . A maioria dos casos de aneurismas na infância permanece ainda com etiologia obscura, e a tendência tem sido adotar uma visão moderada, envolvendo ambas as teorias, hemodinâmica/ degenerativa e congênita, ou seja o desenvolvimento de um aneurisma é considerado fenômeno degenerativo adquirido, associado a defeitos congênitos da camada média 81012,13 .…”

“…Deve-se ressaltar, entretanto, que a incidência deste último é significativamente menor na população infantil, após uma hemorragia subaracnóide 11,14 . Muitos autores defendem a abordagem precoce, prevenindo-se o ressangramento e o vasoespasmo 4 -813 .…”

Rapid de novo aneurysm formation after clipping of a ruptured middle cerebral artery aneurysm in an infant with an MYH11 mutation

“…Cerebral aneurysms in children account for 0.5%-4.6% of those in large reported series of intracranial aneurysms, 5,7,19,21,24,28,32 and lesions diagnosed in the first 2 decades of life account for 1%-4% of all intracranial aneurysms. 12,15,17,29 Compared with those in adults, cerebral aneurysms in young children are more often nonsaccular, dissecting, or fusiform.…”

“…5,7,19,21,24,28,32 Aneurysms in the first 2 decades of life account for 1%-4% of all intracranial aneurysms. 12,15,17,29 As in adults, the treatment of intracranial aneurysms in children can involve microsurgical clip ligation, wrapping, and endovascular treatment including flow diversion, coiling, and embolization of the aneurysm and parent vessel.…”