The clinical features and treatment of pediatric intracranial aneurysm

Liang, Jiantao; Bao, Yijun; Zhang, Hongqi; Wrede, Karsten H.; Zhi, Xiao; Lv, Meng; Li, Feng

doi:10.1007/s00381-008-0725-2

Cited by 73 publications

(67 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The risk of rupture of these aneurysms varied in the literature between 22% and 100% depending on the origin, including dissection, trauma, and infection. 12,17,27,29 Overall, children tend to have better clinical Hunt and Hess grades than adults and they are less susceptible to delayed ischemic deficits from vasospasm. 9,30 Although endovascular coiling has emerged in the past two decades as an alternative modality to surgical clipping or wrapping, both treatment options remain available for ruptured and unruptured cerebral aneurysms.…”

Section: ©Aans 2014mentioning

confidence: 99%

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

Alawi¹,

Edgell

Elbabaa

et al. 2014

PED

View full text Add to dashboard Cite

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.

show abstract

Section: ©Aans 2014mentioning

confidence: 99%

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

Alawi¹,

Edgell

Elbabaa

et al. 2014

PED

View full text Add to dashboard Cite

show abstract

“…Up to 30% of pediatric patients with intracranial aneurysms have medical comorbidities, such as connective tissue disorders, polycystic kidney disease, traumatic aneurysms, and infectious aneurysms, among others, as well as a history of irradiation. 9,10,14 The patient in Case 1 had MOPD Type II. This is a rare autosomal recessive disorder that presents with intrauterine growth retardation, short stature of approximately 100 cm at adulthood, characteristic facial features, skeletal dysplasia, and microcephaly.…”

Section: Posttreatment Coursementioning

confidence: 98%

“…More recently, this trend has been seen in the pediatric population. 10,15 In addition, endovascular coiling has been associated with fewer deaths and shorter hospital stays than those following clip placement. …”

mentioning

confidence: 99%

Flow diversion for complex intracranial aneurysms in young children

Navarro¹,

Brown²,

Beier

et al. 2015

PED

View full text Add to dashboard Cite

Pediatric intracranial aneurysms are exceedingly rare and account for less than 5% of all intracranial aneurysms. Open surgery to treat such aneurysms has been shown to be more durable than endovascular techniques, and durability of treatment is particularly important in the pediatric population. Over the past 2 decades, however, a marked shift in aneurysm treatment from open surgery toward endovascular procedures has occurred for adults. The authors describe their early experience in treating 3 unruptured pediatric brain aneurysms using the Pipeline embolization device (PED). The first patient, a girl with Majewski osteodysplastic primordial dwarfism Type II who was harboring multiple intracranial aneurysms, underwent two flow diversion procedures for a vertebrobasilar aneurysm and a supraclinoid internal carotid artery aneurysm. The second patient underwent PED placement on a previously coiled but enlarging posterior communicating artery aneurysm. All procedures were uneventful, with no postsurgical complications, and led to complete angiographic obliteration of the aneurysms. To the authors' knowledge, this is the first series of flow diversion procedures in children reported in the medical literature. While flow diversion is a new and relatively untested technology in children, outcomes in adults have been promising. For challenging lesions in the pediatric population, flow diversion may have a valuable role as a well-tolerated, safe treatment with durable results. Many issues remain to be addressed, such as the durability of flow diverters over a very long follow-up and vessel response to growth in the presence of an endoluminal device.

show abstract

“…Epistaxis can be the major presentation especially following trauma [2, 4, 14]. Infarcts due to the distal embolization may also be observed [8]. In addition, they may be diagnosed incidentally [2, 4, 5, 12].…”

Section: Discussionmentioning

confidence: 99%

“…For instance, they may present with mass effect-causing compression syndromes such as hemiparesis, cranial neuropathies, and endocrine disturbances, or they can present with the features of elevated intracranial pressure [2-5, 8, 10, 12]. Seizures can be the common symptom for both ruptured and unruptured aneurysms [2-5, 10, 12].…”

Section: Discussionmentioning

confidence: 99%

Acute Obstructive Hydrocephalus due to a Giant Posterior Cerebral Artery Aneurysm in a Pediatric Patient

et al. 2018

View full text Add to dashboard Cite

Introduction: Intracranial aneurysms are very rare in children. Although subarachnoidal hemorrhage (SAH) is by far the most common presentation of aneurysms in the majority of the pediatric case series, it is not rare for an unruptured aneurysm to present with a mass effect. Acute hydrocephalus is a common finding following aneurysmal SAH. However, this malady may develop even in the absence of SAH but secondary to direct obstruction by a giant aneurysm. This situation is extremely rare in children, with only a few known case reports in the literature. Case Report: We report the case of a 10-year-old girl who presented with signs and symptoms of acute hydrocephalus; further radiological evaluation revealed obstructive hydrocephalus and a giant posterior cerebral artery aneurysm. Following endovascular treatment of the aneurysm, hydrocephalus was completely resolved, and the patient was symptom free. Conclusion: Although they are very rare, giant intracranial aneurysms must be kept in mind during the differential diagnosis of pediatric acute hydrocephalus cases. Hydrocephalus may resolve spontaneously after the successful treatment of these aneurysms.

show abstract

The clinical features and treatment of pediatric intracranial aneurysm

Cited by 73 publications

References 26 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

Flow diversion for complex intracranial aneurysms in young children

Acute Obstructive Hydrocephalus due to a Giant Posterior Cerebral Artery Aneurysm in a Pediatric Patient

Contact Info

Product

Resources

About