Management of Pediatric Posterior Circulation Aneurysms—12-Year Single-Institution Experience

AIM:To analyze the demographic characteristics and surgical outcomes of the largest series of patients with pediatric aneurysms reported in Romania, in consideration of the primary factors that lead to good long-term outcomes. Given that all cases involved ruptured aneurysms, we also investigated the ability of microsurgical clipping to prevent massive hemorrhage andaggravation of neurological deficits. MATERIAL and METHODS:This multicenter retrospective study included 47 pediatric patients (<16 years old) who underwent operation over the 20-year period between January 1999 and January 2019. We analyzed medical records and imaging findings in each patient. Treatment consisted of open microsurgical dissection (clipping) and endovascular embolization (coiling). RESULTS:Mean patient age was 14.3 years, ranging from 5 months to 16 years, with 28 boys (59.5%) and 19 girls (40.4%). In our series, pediatric aneurysms represented 6.1% of all intracranial aneurysms (771 cases). Clinical features were dominated by headache (45 cases, 95.7%), neck stiffness (43 cases, 91.4%) and vomiting (42 cases, 89.3%). The most frequently involved locations were the anterior communicating artery (17 cases, 36.1%), middle cerebral artery (12 cases, 25.5%), and internal carotid artery bifurcation (9 cases, 19.1%). Glasgow Outcome Scale scores at 6 months indicated good recovery in 36 patients (76.5%), moderate disability in ninepatients (19.1%), severe disability in one patient (2.1%), and (preoperative) death in one patient (2.1%). CONCLUSION:Intracranial aneurysms in children are very rare. Early diagnosis based on brain imaging and microsurgical treatment is essential for attaining excellent results.Primary factors such as preoperative status, child profile, aneurysm size, treatment choice, and timing of the operation influence both short and long-term outcomes.

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“…Previous studies have reported that the incidence of IAs in the posterior circulation is higher in children than in adults (6).…”

Section: █ Materials and Methodsmentioning

confidence: 84%

Characteristics and surgical outcomes of pediatric intracranial aneurysms in romania

Ciurea

Mohan²,

Voicu³

et al. 2021

Turkish Neurosurgery

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“…Management may be conservative or active which, in turn, takes the form of surgical clipping of the aneurysm or endovascular stenting and embolization. Treatment has become increasingly endovascular with positive outcomes widely reported—Garg et al showed 90% of cases scoring 4 to 5 on the Glasgow Outcome Scale, 8 and Aryan et al recording 42 of 54 cases with excellent or good long-term outcomes, 9 with poor long-term outcomes, and 1 death (2 patients were lost to follow-up). 7 Ideally, these patients are to be managed in neurosurgical centers with microneurosurgical and endovascular options available to clinicians in order to minimize morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…5 As in the case of our patient, 4 of 54 patients in a Californian case series had aneurysms affecting the basilar or vertebral arteries, 7 a slightly lower incidence than found in a single center Indian case series that reported 32% of patients with aneurysms at the vertebrobasilar junction. 8 While the structure of these tends to be more complex in children, 7 the form of aneurysms has been subdivided into fusiform, saccular, mycotic, or traumatic, with saccular aneurysms most likely to present with hemorrhage. 9,10 The majority of aneurysms are dissecting at the point of diagnosis, with most children collated in case reports and series presenting with subarachnoid hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 The majority of aneurysms are dissecting at the point of diagnosis, with most children collated in case reports and series presenting with subarachnoid hemorrhage. 7,8 Nonhemorrhagic presentations are with signs of ischemiaalthough there is a lower incidence of vasospasm in younger patients-or with signs of raised intracranial pressure from mass effect caused by the lesion. 5 This varying nature of presentation goes some way to reflecting the heterogeneous nature of the aneurysms themselves.…”

Section: Discussionmentioning

confidence: 99%

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The Headache You Do Not Want to Miss

Greenbury

2019

Clin Pediatr (Phila)

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Vertebral Artery Aneurysm: Large, Dissecting V4 Aneurysm in a Young Child, Treated with Parent Vessel Occlusion and Reconstruction of the Contralateral Vertebral Artery

Dorn¹

2020

The Aneurysm Casebook

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Management of Pediatric Posterior Circulation Aneurysms—12-Year Single-Institution Experience

Cited by 10 publications

References 35 publications

Characteristics and surgical outcomes of pediatric intracranial aneurysms in romania

Characteristics and surgical outcomes of pediatric intracranial aneurysms in romania

The Headache You Do Not Want to Miss

Vertebral Artery Aneurysm: Large, Dissecting V4 Aneurysm in a Young Child, Treated with Parent Vessel Occlusion and Reconstruction of the Contralateral Vertebral Artery

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