Paediatric aneurysms – Review of endovascular treatment strategies

Bhogal, Pervinder; Pérez, Marta Aguilar; Wendl, Christina; Bäzner, Hansjörg; Ganslandt, Oliver; Henkes, Hans

doi:10.1016/j.jocn.2017.08.009

Cited by 15 publications

(32 citation statements)

References 41 publications

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“…Although the use of flow diversion has been demonstrated in children, 20–22 our case represents the first instance of use of PED-Shield in a pediatric patient with an IIA. Our reasons for placing a flow diverter were 1) the presence of a second, more distal IIA along the left MCA that was not amenable to direct coil embolization, 2) the significant potential for aneurysm regrowth and need for further treatment, and 3) our belief that the parent MCA vessel was diseased and needed to be reconstructed.…”

Section: Discussionmentioning

confidence: 84%

Successful flow diversion treatment of ruptured infectious middle cerebral artery aneurysms with the use of Pipeline Flex with Shield technology

Samples¹,

Ravindra

Thoms³

et al. 2021

Interv Neuroradiol

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Background Rupture of infectious intracranial aneurysms (IIAs) is associated with a high likelihood of mortality. Endovascular treatment of IIAs via parent artery sacrifice offers good efficacy and outcomes; however, depending on the lesion’s location, neurologic deficit may result. Case description We describe a pediatric patient with ruptured IIAs off the left middle cerebral artery (MCA) treated with coil embolization and endovascular flow diversion using the Pipeline Flex Embolization Device (PED) with Shield technology. We chose to place a flow diverter because 1) there was a second, more distal IIA not amenable to direct coil embolization, 2) there was significant potential for aneurysm regrowth and need for retreatment, and 3) we believed the diseased parent MCA needed to be reconstructed. Conclusions In the setting of previous hemicraniectomy, PED-Shield gave us the option to discontinue dual antiplatelet therapy should the patient require further neurosurgical intervention. Our case supports a role for PED-Shield to address ruptured pseudoaneurysms.

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Section: Discussionmentioning

confidence: 84%

Successful flow diversion treatment of ruptured infectious middle cerebral artery aneurysms with the use of Pipeline Flex with Shield technology

Samples¹,

Ravindra

Thoms³

et al. 2021

Interv Neuroradiol

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“…Our clinical practice in treating pediatric intracranial aneurysms reflects the rise in endovascular techniques over the past 30 years. 4,12,15,16,19,28,33 While only 2 aneurysms (25.0%) were treated endovascularly between 1991 and 2001 at our institution, 5 aneurysms (35.7%) were treated endovascularly between 2002 and 2011, and 8 (33.3%) were treated endovascularly in the next decade (Table 5). As an institution, we were relatively early adopters of endovascular technology when we successfully treated a giant, left cavernous ICA pediatric aneurysm with balloon occlusion in 1994.…”

Section: Discussionmentioning

confidence: 90%

“…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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“…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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Paediatric aneurysms – Review of endovascular treatment strategies

Cited by 15 publications

References 41 publications

Successful flow diversion treatment of ruptured infectious middle cerebral artery aneurysms with the use of Pipeline Flex with Shield technology

Successful flow diversion treatment of ruptured infectious middle cerebral artery aneurysms with the use of Pipeline Flex with Shield technology

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

Intracranial Aneurysm in Pediatric Population: A Single-Center Experience

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