Intracranial pediatric aneurysms: endovascular treatment and its outcome

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The aim of this study was to analyze the location, clinical presentation, and morphological characteristics of pediatric aneurysms and the safety, feasibility, and durability of endovascular treatment.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors conducted a retrospective study of all cases involving patients 18 years old or younger who underwent endovascular treatment for pediatric aneurysms at their institution between July 1998 and July 2010. The clinical presentation, aneurysm location, endovascular management, and treatment outcome were studied.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>During the study period, 23 pediatric patients (mean age 13 years, range 2 months–18 years) were referred to the authors' department and underwent endovascular treatment for aneurysms. The aneurysms were saccular in 6 cases, dissecting in 4, infectious in 5, and giant partially thrombosed lesions in 8. Fourteen of the aneurysms were ruptured, and 9 were unruptured. Thirteen were in the anterior circulation and 10 in the posterior circulation. The most common location in the anterior circulation was the anterior communicating artery; in the posterior circulation, the most common location was the basilar artery. Saccular aneurysms were the most common type in the anterior circulation; and giant partially thrombosed and dissecting aneurysms were the most common types in the posterior circulation. Coil embolization was performed in 7 cases, parent vessel sacrifice in 10, flow reversal in 3, glue embolization in 2, and stent placement in 1. Immediate angiographic cure was seen in 21 (91%) of 23 patients. Complications occurred in 4 patients, 3 of whom eventually had a good outcome. No patient died. Overall, a favorable outcome was seen in 22 (96%) of 23 patients. Follow-up showed stable occlusion of aneurysms in 96% of the patients.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Pediatric aneurysms are rare. Their clinical presentation varies from intracranial hemorrhage to mass effect. They may also be found incidentally. Among pediatric patients with aneurysms, giant aneurysms are relatively common. Endovascular management is associated with low rates of complications and is a safe, durable, and effective treatment for pediatric aneurysms.</jats:p></jats:sec>

Radiological Changes in Infantile Dissecting Anterior Communicating Artery Aneurysm Treated Endovascularly

“…There are also some differences in aneurysm location between pediatric and adult patients. In children, aneurysms are more commonly found in the posterior circulation and internal carotid artery bifurcation [11][12][13] , and ACoA aneurysms account for 3-16.2% 11,19,20 . Moreover, the distribution of aneurysms differs slightly between children and infants, in whom many aneurysms are located in the anterior circulation (76%) and in whom aneurysms of the MCA are nearly three times more prevalent than in any other vessel 10 .…”

“…Cases of aneurysmal rupture account for 57% to more than 70% in children 11,13,18 and 73% in infants 10 . There are also some differences in aneurysm location between pediatric and adult patients.…”

“…However, long-term efficacy in children remains unclear because no studies with extended post-treatment follow-up periods have been performed thus far. To our knowledge, only seven cases of endovascular treatment of ruptured spontaneous dissecting aneurysms in infants have been reported, but without information on long-term outcomes 1,12,13,17 . We are also unaware of any case of an infant being treated endovascularly for spontaneous dissecting aneurysm located in the anterior communicating artery (ACoA).…”

“…Moreover, the ratio of dissecting aneurysms is high (16-45%) in children 1,[11][12][13] , and Lasjaunias et al demonstrated the tendency for the rate of dissecting aneurysms to increase with younger age 1 .…”

“…Endovascular treatment of intracranial aneurysms leads to a better clinical outcome than surgical clipping, especially when rupture has occurred 14 , and is currently being applied to pediatric cases and achieving good outcomes 13,15,16 . However, long-term efficacy in children remains unclear because no studies with extended post-treatment follow-up periods have been performed thus far.…”