Ruptured intracranial aneurysms in the first two decades of life

Patel, Aneel N.; Richardson, Alan

doi:10.3171/jns.1971.35.5.0571

Cited by 229 publications

(117 citation statements)

References 6 publications

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“…18,19,26 Aneurysms in children are different from those in adults in several aspects; they are more common in males, with a male to female ratio of almost 3:1, and they tend to be larger, with a higher incidence of giant aneurysms in children compared with adults. [13][14][15]25 Because of the latter difference, aneurysms in children may present with nonhemorrhagic symptoms such as mass effect, headaches, focal neurological deficits, and seizures.…”

Section: ©Aans 2014mentioning

confidence: 99%

Treatment of cerebral aneurysms in children: analysis of the Kids' Inpatient Database

Alawi¹,

Edgell

Elbabaa

et al. 2014

PED

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Object Endovascular coiling and surgical clipping are viable treatment options of cerebral aneurysms. Outcome data of these treatments in children are limited. The objective of this study was to determine hospital mortality and complication rates associated with surgical clipping and coil embolization of cerebral aneurysms in children, and to evaluate the trend of hospitals' use of these treatments. Methods The authors identified a cohort of children admitted with the diagnoses of cerebral aneurysms and aneurysmal subarachnoid hemorrhage from the Kids' Inpatient Database for the years 1998 through 2009. Hospital-associated complications and in-hospital mortality were compared between the treatment groups and stratified by aneurysmal rupture status. A multivariate regression analysis was used to identify independent variables associated with in-hospital mortality. The Cochrane-Armitage test was used to assess the trend of hospital use of these operations. Results A total of 1120 children were included in this analysis; 200 (18%) underwent aneurysmal clipping and 920 (82%) underwent endovascular coiling. Overall in-hospital mortality was higher in the surgical clipping group compared with the coil embolization group (6.09% vs 1.65%, respectively; adjusted odds ratio [OR] 2.52, 95% CI 0.97–6.53, p = 0.05). The risk of postoperative stroke or hemorrhage was similar between the two treatment groups (p = 0.86). Pulmonary complications and systemic infection were higher in the surgical clipping population (p < 0.05). The rate of US hospitals' use of endovascular coiling has significantly increased over the years included in this study (p < 0.0001). Teaching hospitals were associated with a lower risk of death (OR 0.13, 95% CI 0.03–0.46; p = 0.001). Conclusions Although both treatments are valid, endovascular coiling was associated with fewer deaths and shorter hospital stays than clip placement. The trend of hospitals' use of coiling operations has increased in recent years.

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Section: ©Aans 2014mentioning

confidence: 99%

Treatment of cerebral aneurysms in children: analysis of the Kids' Inpatient Database

Alawi¹,

Edgell

Elbabaa

et al. 2014

PED

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“…5,6,9,22,25,26,30 Such aneurysms tend to be larger, more complex in angioarchitecture, and have a higher incidence in boys, as compared with cerebral aneurysms in the adult population. Seventysix percent of pediatric aneurysms are located in the anterior circulation, with MCA aneurysms three times more prevalent than other anterior circulation locations.…”

Section: Discussionmentioning

confidence: 99%

Stent-assisted coil embolization of a symptomatic middle cerebral artery aneurysm in an infant

Savastano¹,

Chaudhary

Gemmete

et al. 2014

PED

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Pediatric intracranial aneurysms are rare and challenging to treat. Achieving efficacy and durability of aneurysmal occlusion while maintaining parent vessel patency requires innovative treatment strategies, especially in cases in which aneurysmal location or morphology pose substantial morbidity associated with microsurgical treatment. In the last 3 decades, endovascular treatments have had a remarkable evolution and are currently considered safe and effective therapeutic options for cerebral aneurysms. While endovascular techniques are well described in the English literature, the endovascular management of pediatric aneurysms continues to pose a challenge. In this report, the authors describe the case of a 9-month-old infant who presented with a 1-day history of acute-onset left-sided hemiparesis and left facial droop. Imaging revealed a large symptomatic saccular middle cerebral artery aneurysm. Treatment included successful stent-assisted aneurysm coiling. At follow-up, the patient continued to fare well and MR angiography confirmed complete occlusion of the aneurysm dome. This case features the youngest patient in the English literature to harbor an intracranial aneurysm successfully treated with stent-assisted coiling. Based on this experience, endovascular intervention with vascular reconstruction can be safe and effective for the treatment of infants and could further improve prognosis; however, further studies are necessary to confirm these findings.

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“…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.…”

Section: Epidemiology and Natural Historymentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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

Ravindra

Karsy

Schmidt

et al. 2016

PED

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The authors report the case of a previously healthy 6-month-old girl who presented with right arm and leg stiffening consistent with seizure activity. An initial CT scan of the head demonstrated acute subarachnoid hemorrhage in the basal cisterns extending into the left sylvian fissure. Computed tomography angiography demonstrated a 7 × 6 × 5–mm saccular aneurysm of the inferior M2 division of the left middle cerebral artery. The patient underwent left craniotomy and microsurgical clip ligation with wrapping of the aneurysm neck because the vessel appeared circumferentially dysplastic in the region of the aneurysm. Postoperative angiography demonstrated a small remnant, sluggish distal flow, but no significant cerebral vasospasm. Fifty-five days after the initial aneurysm rupture, the patient presented again with an acute intraparenchymal hemorrhage of the left anterior temporal lobe. Angiogram revealed a circumferentially dysplastic superior division of the M2 branch, with a new 5 × 4–mm saccular aneurysm distinct from the first, with 2 smaller aneurysms distal to the new ruptured aneurysm. Endovascular parent vessel occlusion with Onyx was performed. Genetic testing revealed a mutation of the MYH11. To the authors' knowledge, this is the first report of rapid de novo aneurysm formation in an infant with an MYH11 mutation. The authors review the patient's clinical presentation and management and comprehensively review the literature on this topic.

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Ruptured intracranial aneurysms in the first two decades of life

Cited by 229 publications

References 6 publications

Treatment of cerebral aneurysms in children: analysis of the Kids' Inpatient Database

Treatment of cerebral aneurysms in children: analysis of the Kids' Inpatient Database

Stent-assisted coil embolization of a symptomatic middle cerebral artery aneurysm in an infant

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

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