Endovascular Reconstruction of Intracranial Aneurysms with the Pipeline Embolization Device in Pediatric Patients: A Single-Center Series

Abstract

Background: Pediatric intracranial aneurysms tend to differ in etiology, size, and location from their adult counterparts, and they are often less amenable to microsurgical clip reconstruction techniques. Endovascular treatment with detachable coils is an accepted treatment technique for pediatric patients, though high recurrence rates have been reported with coil embolization of large and giant aneurysms in this population. While the Pipeline Embolization Device (PED) is FDA-approved for adult intracranial aneurysms, the use of PEDs in pediatric patients is considered off-label. Case Descriptions: We present 3 cases of pediatric intracranial aneurysms in a 5-year-old male, a 12-year-old male, and a 12-year-old female who presented with symptoms including seizure, headache, and blurred vision. The 2 male patients were found to have intradural vertebral artery saccular aneurysms, while the female patient had a paraophthalmic right internal carotid complex aneurysm. After endovascular reconstruction of the aneurysms with PEDs, follow-up angiography showed complete occlusion of the previous aneurysms with no residual aneurysm filling in all 3 cases. Conclusion: While further investigation is needed, the evidence presented here supports the conclusion that the PED can be an effective and viable treatment strategy in the pediatric population.

Therapeutic dilemmas regarding giant aneurysms of the intracranial vertebral artery causing medulla oblongata compression

“…A total of 45 articles containing 53 patients (53 aneurysms) were identified. 3–47 In addition to the 53 patients identified in the literature, we also included two typical cases for illustration which were not included in the final analysis (Figures 2, 3 and 4).…”

“…Giant aneurysms of the intracranial VA are rare intracranial lesions, and only 53 reported cases were identified in this review. 3–47 The intracranial segment of the VA runs along the anterolateral aspect of the medulla oblongata. Aneurysms originating from the intracranial segment of VA are rare and often dissecting aneurysms, 48 and most of them are stable and do not rupture.…”

“…In addition to aneurysm trapping, conventional stent-assisted coiling and FDSs have also been used. 46 However, treatments with aneurysm reserving may lead to postprocedural enlargement of the aneurysm due to thrombus formation in the aneurysm cavity, and thus resulting in catastrophic consequences. Postprocedural deterioration after EVT may occur within the first month.…”

Risk factors for repeated recurrence of cerebral aneurysms treated with endovascular embolization

“…Ever since the short-, medium-, and long-term results of the International Subarachnoid Hemorrhage Trial (ISAT) were published (1)(2)(3), the proportion of endovascular embolization for intracranial aneurysms has been increasing (4)(5)(6)(7)(8)(9)(10)(11). Endovascular embolization of cerebral aneurysms is no longer an alternative to surgical clipping, but one of the preferred treatment approaches (4,5,(10)(11)(12)(13).…”

“…Ever since the short-, medium-, and long-term results of the International Subarachnoid Hemorrhage Trial (ISAT) were published (1)(2)(3), the proportion of endovascular embolization for intracranial aneurysms has been increasing (4)(5)(6)(7)(8)(9)(10)(11). Endovascular embolization of cerebral aneurysms is no longer an alternative to surgical clipping, but one of the preferred treatment approaches (4,5,(10)(11)(12)(13). Compared with surgical clipping of aneurysms, interventional embolization has a lower mortality and disability rate (14-16), and after endovascular embolization, both the incidence of epilepsy and the ratio of cognitive impairment have decreased significantly (3,17).…”