Pediatric intracranial aneurysms—clinical characteristics and outcome of surgical treatment

Sharma, Bhawani S.; Sinha, Sumit; Mehta, Veer Singh; Suri, Ashish; Gupta, Aditya; Mahapatra, AK

doi:10.1007/s00381-006-0253-x

Cited by 61 publications

(61 citation statements)

References 38 publications

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“…Multimodal treatment strategies are now widely used as a standard approach in the care of these patients [2,3,4,5,6,7] and have therefore resulted in significant improvements in patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Intracranial Aneurysms: An Institutional Experience

Vaıd¹,

Kumar²,

Kalra³

et al. 2008

Pediatr Neurosurg

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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.

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Section: Discussionmentioning

confidence: 99%

Pediatric Intracranial Aneurysms: An Institutional Experience

Vaıd¹,

Kumar²,

Kalra³

et al. 2008

Pediatr Neurosurg

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“…12,17,27,29 Overall, children tend to have better clinical Hunt and Hess grades than adults and they are less susceptible to delayed ischemic deficits from vasospasm. 9,30 Although endovascular coiling has emerged in the past two decades as an alternative modality to surgical clipping or wrapping, both treatment options remain available for ruptured and unruptured cerebral aneurysms. There has been a growing interest in endovascular technology as several studies have suggested a lower procedural mortality rate, higher 1-year survival, lower incidence of vasospasm, and a cost benefit with this technology.…”

Section: ©Aans 2014mentioning

confidence: 99%

Treatment of cerebral aneurysms in children: analysis of the Kids' Inpatient Database

Alawi¹,

Edgell

Elbabaa

et al. 2014

PED

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Object Endovascular coiling and surgical clipping are viable treatment options of cerebral aneurysms. Outcome data of these treatments in children are limited. The objective of this study was to determine hospital mortality and complication rates associated with surgical clipping and coil embolization of cerebral aneurysms in children, and to evaluate the trend of hospitals' use of these treatments. Methods The authors identified a cohort of children admitted with the diagnoses of cerebral aneurysms and aneurysmal subarachnoid hemorrhage from the Kids' Inpatient Database for the years 1998 through 2009. Hospital-associated complications and in-hospital mortality were compared between the treatment groups and stratified by aneurysmal rupture status. A multivariate regression analysis was used to identify independent variables associated with in-hospital mortality. The Cochrane-Armitage test was used to assess the trend of hospital use of these operations. Results A total of 1120 children were included in this analysis; 200 (18%) underwent aneurysmal clipping and 920 (82%) underwent endovascular coiling. Overall in-hospital mortality was higher in the surgical clipping group compared with the coil embolization group (6.09% vs 1.65%, respectively; adjusted odds ratio [OR] 2.52, 95% CI 0.97–6.53, p = 0.05). The risk of postoperative stroke or hemorrhage was similar between the two treatment groups (p = 0.86). Pulmonary complications and systemic infection were higher in the surgical clipping population (p < 0.05). The rate of US hospitals' use of endovascular coiling has significantly increased over the years included in this study (p < 0.0001). Teaching hospitals were associated with a lower risk of death (OR 0.13, 95% CI 0.03–0.46; p = 0.001). Conclusions Although both treatments are valid, endovascular coiling was associated with fewer deaths and shorter hospital stays than clip placement. The trend of hospitals' use of coiling operations has increased in recent years.

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“…Intracranial aneurysm occurs infrequently in the pediatric population as compared to adults, with most of the large series reporting an incidence of only 0.5–4% [1,2,3,4,5]. The pediatric counterparts are associated with a male predominance, predilection for the ICA bifurcation and the posterior circulation with a higher incidence of giant aneurysms and a good outcome as compared to adults [5, 22, 25].…”

Section: Discussionmentioning

confidence: 99%

“…The pediatric counterparts are associated with a male predominance, predilection for the ICA bifurcation and the posterior circulation with a higher incidence of giant aneurysms and a good outcome as compared to adults [5, 22, 25]. The occurrence of aneurysm in neonates is further uncommon.…”

Section: Discussionmentioning

confidence: 99%

“…Intracranial arterial aneurysms are uncommon in the pediatric age group, with studies reporting a very low incidence of the same varying from 1 to 4.7% [1,2,3,4,5]. Their occurrence in the neonatal age group (up to 28 days) is exceptional, with only 20cases being reported in the literature as per an extensive review by the authors [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24].…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous Thrombosis of Giant Cavernous Internal Carotid Artery Aneurysm in a Neonate

et al. 2008

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Neonatal intracranial aneurysms are rare, with only 20cases being reported in the literature. No case of spontaneous resolution of a giant intracranial cavernous segment aneurysm in a neonate is reported till date. The authors describe a 3-week-old male child who presented with a left-sided tonic seizure episode and was diagnosed as having a right-sided giant cavernous internal carotid artery aneurysm. The aneurysm was found to be totally thrombosed on angiography done before planning definitive treatment. The child is doing well at 2 years of follow-up. Spontaneous thrombosis, an exceptionally rare but fortunate outcome in a rare case of giant neonatal internal carotid artery aneurysm, has led the authors to report this case. The need of repeat imaging or angiography should be considered to rule out this rare outcome, more so if there is any delay between the ictus and treatment.

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Pediatric intracranial aneurysms—clinical characteristics and outcome of surgical treatment

Cited by 61 publications

References 38 publications

Pediatric Intracranial Aneurysms: An Institutional Experience

Pediatric Intracranial Aneurysms: An Institutional Experience

Treatment of cerebral aneurysms in children: analysis of the Kids' Inpatient Database

Spontaneous Thrombosis of Giant Cavernous Internal Carotid Artery Aneurysm in a Neonate

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