Clinical and radiological profiles and outcomes in pediatric patients with intracranial aneurysms

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Intracranial aneurysms are extremely uncommon in the pediatric population, their characteristics are not well studied, and certain features make them unique. The authors analyzed pediatric patients with aneurysms to try to understand their clinical, radiological, and outcome profile.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Sixty-three pediatric patients (≤ 18 years of age) with ages ranging from 4 to 18 years and features (clinical and radiological) suggestive of aneurysm presented to, and were treated at, the authors' center in the past 20 years (1991–2011). Included in the present study were only those patients who underwent surgical intervention, and thus data for 57 patients were analyzed.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Seventy-three aneurysms in 57 patients were surgically treated. There was a slight female predominance (M/F 1:1.2), and the mean age among all patients was 12.69 ± 3.75 years. Fifty patients (87.72%) presented with subarachnoid hemorrhage, 4 (7.02%) with mass effect, and 3 (5.26%) with seizure. On presentation the majority of patients (45 [78.95%]) had a good clinical grade. Eleven patients had multiple aneurysms. The internal carotid artery (ICA) bifurcation was the most common aneurysm site (18 cases [24.66%]), followed by the middle cerebral artery (MCA) bifurcation (11 cases [15.07%]). At a mean follow-up of 18.58 ± 10.71 months (range 1.5–44 months), 44 patients (77.19%) had a favorable outcome, and 5 patients had died.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Pediatric patients with intracranial aneurysms most commonly presented with subarachnoid hemorrhage, and there was a slight female predominance. The ICA bifurcation followed by the MCA bifurcation was the most common aneurysm site. The incidence of posterior circulation and giant aneurysms is higher in pediatric patients than in the adult population. Children tend to present with better clinical grades and have better overall survival results and good functional outcomes.</jats:p></jats:sec>

Patterns of treatment and associated short-term outcomes of unruptured intracranial aneurysms in children

“…Dissecting aneurysms in particular can lead to mass effect, hemorrhage, or ischemia [6]. There are few reports of incidentally found UIA in children during routine autopsy studies [6,8]. Given that a majority of pediatric UIAs are symptomatic, treatment is important in order to prevent aneurysm rupture or worsening of symptoms due to UIA.…”

“…The incidence of intracranial aneurysms is estimated to range from 0.5 to 4.6 % among those 18 years of age or younger [1,3,8,[10][11][12]. Aneurysms in the pediatric population differ significantly from those in the adult population.…”

Flow Diverters in the Treatment of Pediatric Cerebrovascular Diseases

“…[16][17][18] Saraf et al 19 reported that endovascular management is a safe, durable, and effective treatment for pediatric intracranial aneurysms. Considering the substantial rise in the use of flow diverters among all contemporary endovascular devices in adults, it is expected that these devices will be used with increasing frequency in the pediatric population.…”

Extent of collateralization predicting symptomatic cerebral vasospasm among pediatric patients: correlations among angiography, transcranial Doppler ultrasonography, and clinical findings

“…The reason for the better clinical grades at presentation is unclear but may be attributable to several factors, such as few comorbidities and a greater tendency among physicians to refer cerebrovascular cases to tertiary care centers. 31 Second, good long-term outcomes may be partially attributable to the low prevalence of symptomatic CV due to the robustness of the cerebral collateral circulation in children. However, the 3 children who experienced symptomatic CV also had relatively good long-term outcomes.…”