History of surgery for cerebrovascular disease in children. Part I. Intracranial arterial aneurysms

Abstract

<jats:p>✓ Intracranial aneurysms are rare in children, and their origins and treatment methods tend to be different from those in these same entities in adults. These lesions tend to be congenital or to have an infectious or traumatic origin. In the current paper the authors trace the historical evolution of the diagnosis and treatment of intracranial aneurysms in children. Based on the literature, these lesions appear to occur in children in less than 3% of all series. The literature also supports the suggestion that symptoms from these aneurysms are often from mass effect and that giant aneurysms and lesions in the posterior cranial fossa are relatively more common in children than in adults. The termination of the carotid artery and the anterior cerebral artery seem to be disproportionately common sites of aneurysm formation in this cohort. Interestingly, surgical outcomes in children appear to be moderately better than in adults. Based on the literature, the claim can be made that a multidisciplinary approach to the management of such aneurysms can yield good outcomes in a very high percentage of children treated.</jats:p>

Scope of practice and outcomes of cerebrovascular procedures in children

“…Treatment of these patients can be demanding given the challenges of the pathology in this particular age group. [3,5,4] Little attention has been paid to the impact of the scope of practice of treating providers and the outcomes of this population.…”

“…[3,5,4,15,9,10,8] Due to the rarity of this pathology in pediatric patients, most investigations are retrospective analyses of single center experiences. Their results, therefore, have limited generalization.…”

“…They were able to report on only 32 patients with 78% good neurological recovery. The common denominator of all these experiences[3,5,4,15,9,10,8] is that pediatric cerebral aneurysms are more commonly giant or fusiform, posterior circulation based, and present with mass effect rather than subarachnoid hemorrhage. Additionally, mycotic aneurysms are more frequently observed in children in comparison to adults (10% versus 2–3% respectively of all cerebral aneurysms).…”

“…Pediatric patients have significantly smaller blood vessels, less atherosclerotic burden, higher frequency of syndromic pathology with multiple lesions, and diseases that are extremely rare in adults, such as Moyamoya or vein of Galen malformations. [3,5,4] Pediatric neurosurgery requires extensive post-residency training to familiarize the physician with the specific challenges of this age group.…”

“…Prior studies of cerebrovascular interventions in children have reported the outcome of treating cerebral aneurysms, arteriovenous malformations (AVMs), and vein of Galen malformations, and have demonstrated differences in characteristics and management in comparison to adults. [3,5,4,15,9,10,8] No prior study has investigated the association of scope of practice with the outcomes of cerebrovascular interventions in a comprehensive cohort of pediatric patients.…”