Endovascular Management of Paediatric Intracranial Aneurysms

Abstract

<jats:p> The purpose of this paper is to discuss the radiological and clinical features of paediatric intracranial aneurysms including endovascular techniques currently being used for their therapy. Paediatric patients who presented with the diagnosis of intracranial aneurysm between August 1982 and February 1997 were included. The data were collected retrospectively. </jats:p><jats:p> Clinical features included patient's age, sex, presentation, treatment and outcome. Radiologic features included location, size and number of aneurysms present. </jats:p><jats:p> 21 patients (13 females and 8 males) ranging in age from 9 months to 16 years had intracranial aneurysms. Seventy six percent of the aneurysms were located in the anterior circulation and 24% in the posterior circulation. Seven patients (33%) had giant aneurysms and three patients (14%) had multiple aneurysms. Endovascular treatment was performed in six patients (29%) and neurosurgical treatment in eight patients (38%). Endovascular treatment included the use of coils and/or balloon occlusion. </jats:p><jats:p> Of the remaining patients, two (9.5%) died prior to any surgical or radiological intervention. A further five patients (24%) were treated conservatively. Intracranial aneurysms in children demonstrate clinical and radiologic features that differ significantly from those seen in adults. There is a higher percentage of ICA termination aneurysms, giant aneurysms and post-traumatic aneurysms. </jats:p><jats:p> However, aneurysms in children, like those in adults, can and have been successfully treated utilizing endovascular as well as neurosurgical techniques. </jats:p>

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

“…This increase in coil embolization compared with surgical clipping operations may be due to the observed good outcome rates associated with coil embolization in previous studies. 1,6,8,15,16,20 This study has several limitations. First and foremost, we were unable to address information about aneurysm morphology, anatomical location, and other clinical characteristics such as the clinical grade that might affect decision making in selecting the type of treatment.…”

“…There has been no similar clinical trial to compare these treatment options in children. Although there are observational studies addressing the efficacy and safety of endovascular coiling and clipping in children, 1,14,16,27 the largest study included only 33 patients with 37 aneurysms, which showed better clinical outcomes associated with coiling compared with clipping. 1 Because of the lack of evidence in children with intracranial aneurysms, and because of the small sample size in most published series, we sought to evaluate these treatment options in a large sample abstracted from a national database.…”

Surgically Managed Pediatric Intracranial Aneurysms: How Different Are They from Adult Intracranial Aneurysms?

“…This does not have a bearing on the clinical condition or development of delayed ischemic neurologic deficits, however [8,14] , and children generally tolerate vasospasm well. In our series, the incidence of angiographic vasospasm was 16.3%, but there was no clinical evidence of spasm and all had excellent outcomes, with the probable explanation being the robust leptomeningeal collaterals in children and the ability of the young brain to withstand ischemic insult [1,7,17] . Ischemic insult due to vasospasm was seen in 27% our adult cases.…”

“…ICA bifurcation aneurysms were seen in only 3.8% of the cases in adults. Posterior circulation aneurysms occur more commonly in children than in adults (up to 3 times more common) [15] ; they can be seen in about 24-39% of children [1,17] and 5.5-8% of adults [2,4] . They were seen in 9.1% of our pediatric cases.…”

Endovaskuläre Behandlung eines rupturierten vertebrobasilären Aneurysmas bei einem Kind durch partielle selektive Aneurysmaobliteration und Flußumkehr

“…ie Pr~tvalenz intrakranieller Aneurysmen bei Kindern betr~igt 0,5 bis 4,6% [7,13], wobei die j~ihrli-che Inzidenz von aneurysmatischer Subarachnoidalblutung 1 : 100000 (Erwachsene 10:100000)betr~gt. 13,5 bis 24% der Aneurysmen rinden sich im posterioren Stromgebiet [10] (Erwachsene 5%).…”