Endovascular treatment of a large ruptured middle cerebral artery bifurcation aneurysm in a 5-week-old infant: case report

Abstract

<jats:p>Ruptured intracranial aneurysms are extremely rare in infants. The optimal treatment strategy is not well established. Both microsurgical and endovascular techniques and strategies have been tried, and in the literature there is a significant variability in outcome. The authors report the presentation and successful endovascular treatment of a large, ruptured, middle cerebral artery bifurcation aneurysm in a 5-week-old girl, one of only a few reported in the literature. Clinical and radiological findings at follow-up are also presented. The authors then review the literature on aneurysmal subarachnoid hemorrhage in infants, with particular regard to outcome after either endovascular or open surgical management. They also provide recommendations for follow-up in pediatric patients whose intracranial aneurysms have been treated with coil embolization.</jats:p>

Endovascular Treatment of a Ruptured Distal Anterior Cerebral Artery Aneurysm Using Coils and N-Butyl-Cyanoacrylate in a 5-Month-Old Baby

“…1,4,5,[7][8][9]15 On the other hand, saccular aneurysms are rare and only eight cases have been treated by embolization in patients under 30-month-old with good results. 16 EVT cases have been performed during the first 2 months of life in only two cases. 17 Regarding their location, the internal carotid artery bifurcation followed by middle cerebral artery is the more common site in the anterior circulation.…”

Onyx embolization of a ruptured anterior inferior cerebellar artery in a neonate

“…Posterior circulation aneurysms account for 17-21 of pediatric aneurysms [1,3], and within this group 24 are less than 12 months of age [5]. A recent a review of ruptured aneurysms in infants found only two reports of posterior circulation aneurysms [6].…”

Letter to the Editor. Role of dysplastic and genetic mutations during the formation of cerebral aneurysms in infants

“…The existence of third ventricle bowing, especially third ventricle floor bowing, suggests compliant third ventricle walls and a pressure difference between the third ventricle and the subarachnoid space, which indicate an intraventricular obstructive hydrocephalus and can result higher ETV success. 1 We believe that in patients with chronic hydrocephalus, even if without signs of acutely elevated ICP and transependymal flow, preoperative third ventricle floor bowing can still reflect good compliance of the third ventricle wall and a pressure difference between the ventricle and the subarachnoid space, and these patients therefore can still be treated successfully with ETV.…”

“…Foroughi et al 2 reported an ETV success rate of 96% in patients with preoperative lamina terminalis and third ventricle floor bowing. Dlouhy et al 1 also found that preoperative third ventricle bowing was a good predictor of ETV success, and they reported that patients with third ventricle bowing had a 3-fold likelihood of success compared with those without such bowing. The existence of third ventricle bowing, especially third ventricle floor bowing, suggests compliant third ventricle walls and a pressure difference between the third ventricle and the subarachnoid space, which indicate an intraventricular obstructive hydrocephalus and can result higher ETV success.…”