Pediatric Intracranial Aneurysms: An Institutional Experience

Abstract

Introduction: Intracranial aneurysms are extremely uncommon in the pediatric population. Their epidemiology is poorly understood, and certain features make them unique. In our study we analyzed pediatric intracranial aneurysm patients to gain an insight into the epidemiology, clinicoradiological profile and outcome. Material and Methods: Out of 36 children (≤18 years of age; male:female ratio = 1.076:1; mean age 13.19 ± 3.72 years, age range 5–18 years) presenting with subarachnoid hemorrhage (SAH; n = 33; 91.67%) and mass effect (n = 3; 8.33%), 27 who were positive on digital subtraction angiography and treated for intracranial aneurysms between January 1991 and February 2007 were included in this study. Results: At presentation, the majority (n = 21) of the pediatric intracranial patients showed a good grade, and 23 (85.18%) presented with SAH. Sudden severe headache (n = 19; 70.37%) and loss of consciousness (n = 14; 51.85%) were the most common symptoms, and meningeal signs (n = 18; 66.66%) most commonly elicitable. There were 7 patients with giant aneurysms and 8 patients with posterior circulation aneurysms. Internal carotid artery (ICA) bifurcations (n = 6; 18.18%) followed by middle cerebral artery (MCA) bifurcations (n = 4; 12.12%) were the most common sites. At a mean follow-up of 18.67 ± 10.85 months (range 1–42 months), there were 21 (77.77%) patients with favorable outcome and 3 patients died. Conclusions: Intracranial aneurysms in children commonly present with SAH; there is a male predominance, and ICA bifurcations followed by MCA bifurcations are the most common sites. The incidence of posterior circulation aneurysms and giant aneurysms is higher as compared to adults. The pediatric patients present with better grades and have better overall surgical results.

Surgically Managed Pediatric Intracranial Aneurysms: How Different Are They from Adult Intracranial Aneurysms?

“…In children, it is predominantly congenital factors and hemodynamic stresses that play a role in the development of ICAs [6] . Congenital disorders like coarctation of the aorta, fibromuscular dysplasias, polycystic kidney disease, and the Ehlers-Danlos and Marfan syndromes may be associated with these aneurysms [1,7] . Except for coarctation of the aorta, there were no such associations in our study.…”

“…In our series, 79.5% of the children and 87% of the adults presented with SAH. Children generally present in a good clinical grade (59-78%) [7,8] . Poor grades at presentation are not as high as is seen in adults [12,13] .…”

“…In our series, 20% of the pediatric cases were in a poor grade. Rebleeding is a major cause of mortality and morbidity, and varies from 13 to 48% in pediatric cases [7,14] . Six (11%) of our cases presenting with SAH had rebleed prior to referral.…”

“…A greater percentage of children present with large or giant aneurysms than adults. Over half of pediatric aneurysms are large or giant [7,9] . Angiographic and symptomatic vasospasms are found, respectively, in 30-70% and 20-30% of adult cases [18][19][20]; however, in children, the incidence is very low.…”

Blister-Like Supraclinoid Internal Carotid Artery Pseudoaneurysm in a 15-Year-Old Male: Case Report and Review of the Literature

“…), complex morphology and a fourfold likelihood of symptomatic hemorrhage [2,6]. The proportion of traumatic and infective aneurysms is also much higher in this cohort, with posttraumatic etiologies accounting for 14–39% of all pediatric lesions [6,7,8]. …”