Endovascular Therapeutic Occlusion of the Posterior Cerebral Artery: An Option for Ruptured Giant Aneurysm in a Child

Abstract

The incidence of intracranial aneurysms in the pediatric population is low, and surgical clipping remains a good long-term treatment option. However, posterior circulation aneurysms are even more complex to manage in children than in adults. We report a case of a giant aneurysm of the posterior cerebral artery in a 10-year-old boy presenting with subarachnoid hemorrhage. Endovascular treatment with platinum coils was performed with total occlusion of the aneurysm and the affected arterial segment without complications. The patient achieved good recovery, and a late control angiogram confirmed exclusion of the aneurysm. Occurrence of special features of cerebral aneurysm in children, in comparison to adults, is also described. Parent artery sacrifice is an effective therapeutic option, but long-term follow-up is necessary to avoid recurrence and rebleeding.

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

“…Direct obstruction of the CSF flow by an intracranial aneurysmal mass effect is exceptional in children, and there are only a few case reports regarding this issue in the literature [15, 16]. Rarely, a pediatric giant aneurysm may present with both obstruction and SAH [17]. Vein of Galen aneurysmal malformations, which are rare congenital vascular abnormalities, should not be confused with true aneurysms as they are mostly high-flow arteriovenous fistulas that can also present with obstructive hydrocephalus [18].…”

“…However, at the time of the surgery a clear CSF, without a high protein load and red blood cell count, is a requirement to avoid any further shunt obstruction. An alternative strategy may be a temporary external ventricular drainage (EVD) or an externalized shunt [17]. However, one should keep in mind the relatively high infection and complication rates associated with EVD [20].…”

Endovascular Treatment of a Giant Dissecting Aneurysm in an Infant

“…2 The incidence is very rare before 15 years of age, representing 1% of all aneurysms. 3 Unlike the adult population, there is a male predominance, with a male-to-female ratio of 3:2. 4 The morphology, clinical presentation, and radiological features of aneurysms in infants and children are different from those of aneurysms in adults.…”

“…2 The location of the aneurysms also differs in children, with the internal carotid artery (ICA) being the most common site, accounting for 13 to 50% of the incidence, while posterior circulation aneurysms are also more frequent in children than in adults. 3 However, giant aneurysms ( 25 mm) in infants, on the contrary, arise more frequently in the posterior circulation. 5 Treatment options for pediatric ICA aneurysms include conservative management, direct surgical clipping, cerebral revascularization and an endovascular approach.…”

“…5 Treatment options for pediatric ICA aneurysms include conservative management, direct surgical clipping, cerebral revascularization and an endovascular approach. 3 There is no consensus for the management of pediatric aneurysms and its approach remains individualized on a case-by-case basis. 5 In the present study, we report the case of an infant with a giant, partially thrombosed, carotid-ophthalmic aneurysm, which was treated with parent vessel occlusion by endovascular approach, and present a discussion about the epidemiology, etiology, location and treatment options for aneurysms in the pediatric population.…”