Microsurgical Treatment of Pediatric Intracranial Aneurysms

Kakarla, U Kumar; Beres, Elisa J.; Ponce, Francisco A.; Chang, Steven W.; Deshmukh, Vivek R.; Bambakidis, Nicholas C.; Zabramski, Joseph M.; Spetzler, Robert F.

doi:10.1227/01.neu.0000371727.71991.64

Cited by 102 publications

(106 citation statements)

References 14 publications

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“…Kakarla and colleagues report that approximately 62 % of pediatric UIA are symptomatic [5]. Discovery of UIA is linked to presentations with seizures, non-SAH-related headaches, or another neurological deficit approximately 40 % of the time [3,6].…”

Section: Discussionmentioning

confidence: 99%

“…Durability is of concern when selecting an intervention in children with UIA due to the longer life expectancy [3,12,13]. Kakarla and colleagues retrospectively evaluated this question in 48 children with angiographic follow-up ranging 5-120 months and reported that both endovascular and microsurgical treatments achieved similar results in outcomes and suggested that microsurgical treatment may be equivalent to or better than endovascular treatment for conferring longterm durability and protection; however, follow-up was only reported in 54 % of cases reviewed [5]. Sanai and colleagues reported that while both treatments were fairly successful, endovascular treatment is associated with a recurrence rate of 20-40 %; therefore, microsurgical treatment may be more effective in permanently obliterating aneurysms [10,11].…”

Section: Discussionmentioning

confidence: 99%

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Patterns of treatment and associated short-term outcomes of unruptured intracranial aneurysms in children

et al. 2014

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Background The rates and outcomes of treatments for intracranial aneurysms have not been exclusively determined within the pediatric population. We determined the rates of endovascular and microsurgical treatments for unruptured intracranial aneurysms (UIA) and associated rates of favorable outcome in patients aged <18 years. Methods We analyzed data obtained as part of the Kids' Inpatient Database between 2003 and 2009 with primary diagnosis of UIA. Patients undergoing endovascular treatment were compared to those undergoing microsurgical treatment. We determined rates of intracerebral hemorrhage, subarachnoid hemorrhage, neurological complications, and favorable outcome. Results There were 818 cases of UIA during the study period. A total of 111 patients (mean age 14±6 years, 37.6 % female) underwent microsurgical treatment, and another 200 patients (mean age 13 ± 7 years, 42.5 % female) underwent endovascular treatment. A high rate of favorable outcome was observed in patients who received either treatment (microsurgical treatment 87.7 % versus endovascular treatment 91.6 %, p=0

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patterns of treatment and associated short-term outcomes of unruptured intracranial aneurysms in children

et al. 2014

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“…2,3,[6][7][8][9]12 In the pediatric population and traumatic aneurysms, arguments supporting clip ligation include that it represents definitive treatment of the aneurysm, allows for reconstruction of the parent vessel, and alleviates mass effect of the aneurysm by thrombectomy. 4,6 We chose open surgery for these very reasons. Moreover, we also postulated that the wall of the pseudoaneurysm was thin and coiling would risk rupture.…”

Section: Discussionmentioning

confidence: 99%

Rapid ventricular pacing for a basilar artery pseudoaneurysm in a pediatric patient: case report

Nimjee¹,

Smith²,

Kanter

et al. 2015

PED

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Large cerebral aneurysms of the basilar apex are difficult to treat. Recently, endovascular treatment has mitigated much of the morbidity associated with treating these lesions. However, the morphology of aneurysms of the vertebrobasilar system can preclude endovascular treatment. Rapid ventricular pacing (RVP) facilitates open surgical treatment of cerebral aneurysms. It can assist in reducing the pressure of the neck of the aneurysm, allowing safe application of a clip. The authors present a case of a pediatric patient who developed a basilar artery pseudoaneurysm that required surgery. Given the large size of the aneurysm, RVP was performed, allowing the surgeons to dissect the dome of the aneurysm from the surrounding tissue and pontine perforating branches away from the lesion to safely clip the lesion. The patient had an uneventful recovery. To the authors' knowledge, this represents the first known case of RVP to aid in basilar artery clip occlusion in a pediatric patient.

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“…For surveillance and treatment of pediatric aneurysms, CTA or cerebral angiography are often performed during the acute phase. This is often followed by MRA, which is one of the best imaging modalities for pediatric aneurysms because it provides high-resolution images and is less invasive 11,12,[30][31][32] . However, MRA constructed with the time-of-flight method is strongly affected by speed of blood flow.…”

Section: Discussionmentioning

confidence: 99%

Radiological Changes in Infantile Dissecting Anterior Communicating Artery Aneurysm Treated Endovascularly

et al. 2014

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Intracranial aneurysms are extremely rare in infants, and to our knowledge only seven infants treated for ruptured spontaneous dissecting aneurysms have been reported. Good outcomes have been achieved with endovascular treatment of infantile aneurysm. We the endovascular treatment of a one-month-old girl for ruptured dissecting aneurysm located in the anterior communicating artery, and the unique radiological changes that were observed during the perioperative and follow-up periods. These changes suggest that blood coagulation and fibrinolytic response play a part in the repair and healing processes of dissecting aneurysms. Careful neuroradiological surveys are needed for pediatric dissecting aneurysms treated endovascularly.

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Microsurgical Treatment of Pediatric Intracranial Aneurysms

Abstract: Pediatric aneurysms require complex microsurgical techniques to achieve favorable outcomes. They leave higher rates of recurrence and de novo formation or growth than their adult counterparts, which mandates lifelong follow-up.

Cited by 102 publications

References 14 publications

Patterns of treatment and associated short-term outcomes of unruptured intracranial aneurysms in children

Patterns of treatment and associated short-term outcomes of unruptured intracranial aneurysms in children

Rapid ventricular pacing for a basilar artery pseudoaneurysm in a pediatric patient: case report

Radiological Changes in Infantile Dissecting Anterior Communicating Artery Aneurysm Treated Endovascularly

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