Pediatric Intracranial Aneurysms: New and Enlarging Aneurysms after Index Aneurysm Treatment or Observation

Hetts, Steven W.; English, Joey; Dowd, Christopher F.; Higashida, Randall T.; Scanlon, Jennifer; Vv, Halbach

doi:10.3174/ajnr.a2680

Cited by 37 publications

(28 citation statements)

References 24 publications

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“…[1][2][3] Aneurysms in the first 2 decades of life comprise about 1% to 4% of all intracranial aneurysms. [4][5][6][7] Long-term angiographic follow-up studies in pediatric intracranial aneurysm patients with mean follow-up times of only 4 to 6 years 5,8,9 show de novo aneurysm formation rates of 13% to 23%. 4,5,9 We gathered data on long-term clinical and angiographic follow-up studies of pediatric aneurysm patients in a singlecenter consecutive series.…”

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confidence: 99%

De Novo and Recurrent Aneurysms in Pediatric Patients With Cerebral Aneurysms

Koroknay-Pál

Niemelä

Lehto

et al. 2013

Stroke

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Background and Purpose-Long-term angiographic follow-up studies on pediatric aneurysm patients are scarce. Methods-We gathered long-term clinical and angiographic follow-up data on all pediatric aneurysm patients (≤18 years at diagnosis) treated at the Department of Neurosurgery, Helsinki University Central Hospital, between 1937 and 2009. Results-Fifty-nine patients with cerebral aneurysms in childhood had long-term clinical and radiological follow-up (median, 34 years; range, 4-56 years). Twenty-four patients (41%) were diagnosed with altogether 25 de novo and 11 recurrent aneurysms, with 9 (25%) of the aneurysms being symptomatic. New subarachnoid hemorrhage occurred in 7 patients; 4 of these patients died. Eight patients (33%) had multiple new aneurysms. The annual rate of hemorrhage was 0.4%, and the annual rate for the development of de novo or recurrent aneurysm was 1.9%. There were no de novo aneurysms in 7 patients with previously unruptured aneurysms. However, 1 recurrent aneurysm was diagnosed. Current and previous smoking (risk ratio, 2.44; 95% confidence interval, 1.07-5.55) was the only statistically significant risk factor for de novo and recurrent aneurysm formation in patients with previous subarachnoid hemorrhage, whereas hypertension, sex, or age at onset had no statistically significant effect. Smoking was also a statistically significant risk factor for new subarachnoid hemorrhage. Conclusions-Patients

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confidence: 99%

De Novo and Recurrent Aneurysms in Pediatric Patients With Cerebral Aneurysms

Koroknay-Pál

Niemelä

Lehto

et al. 2013

Stroke

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“…There is no consensus on how often or for how long pediatric aneurysm patients should be followed after acute-phase treatment. Recurrence of aneurysm and the development of de novo aneurysms after the initial procedure have been reported in pediatric cases, and these phenomena are highly likely to be related to dissection or fusiform morphology 32,34 . The incidence of recurrent and de novo aneurysms was reported by Kakarla et al to be 2.6% and 7.8% over a mean follow-up duration of 53 months 32 , and Hetts et al reported that 8.4% developed de novo or enlarging aneurysms an average of 4.2 tively because of unavoidable circumstances, it is important to know in which period spontaneous thrombosis can occur and what will happen afterwards.…”

Section: Discussionmentioning

confidence: 99%

“…Careful neuroradiological surveys are needed for pediatric dissecting aneurysms treated endovascularly. years after initial presentation 34 . Moreover, Sanai et al reported that aneurysm recurrence or the development of de novo aneurysms was frequent in children treated endovascularly during a mean follow-up period of 5.7 years 31 .…”

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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“…3 Pediatric cerebral aneurysms are also more frequently giant, tend to form in the posterior circulation and at the internal carotid artery bifurcation, and have a male preponderance. 19,26,30,33 Fusiform aneurysms are less common in adults, more common in children, 6,11 and frequently occur along the MCA branches. 6 The featured case represents a rare saccular aneurysm arising from the inferior division of M 2 with de novo saccular aneurysm formation at the superior division of M 2 .…”

Section: Epidemiology and Natural Historymentioning

confidence: 99%

“…1,13,14,20,30,34,37 The rate of new SAH is higher in both adults and children with a previous aneurysm rupture than in the general population; it occurs as a result of recurrent aneurysms as well as de novo aneurysm formation. 4,35,39 In pediatric patients with a mean follow-up of 4-6 years, 11,15,30 a 13%-23% cumulative rate of de novo aneurysm formation has been reported. 15,29,30 We discuss the case of a 6-month-old girl who initially presented with a ruptured left middle cerebral artery (MCA) aneurysm treated with microsurgical clip ligation who had de novo aneurysm formation and rupture from an adjacent segment just 55 days later and was found to have a mutation in the myosin heavy chain 11, smooth muscle gene (MYH11).…”

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confidence: 99%

Rapid de novo aneurysm formation after clipping of a ruptured middle cerebral artery aneurysm in an infant with an MYH11 mutation

Ravindra

Karsy

Schmidt

et al. 2016

PED

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The authors report the case of a previously healthy 6-month-old girl who presented with right arm and leg stiffening consistent with seizure activity. An initial CT scan of the head demonstrated acute subarachnoid hemorrhage in the basal cisterns extending into the left sylvian fissure. Computed tomography angiography demonstrated a 7 × 6 × 5–mm saccular aneurysm of the inferior M2 division of the left middle cerebral artery. The patient underwent left craniotomy and microsurgical clip ligation with wrapping of the aneurysm neck because the vessel appeared circumferentially dysplastic in the region of the aneurysm. Postoperative angiography demonstrated a small remnant, sluggish distal flow, but no significant cerebral vasospasm. Fifty-five days after the initial aneurysm rupture, the patient presented again with an acute intraparenchymal hemorrhage of the left anterior temporal lobe. Angiogram revealed a circumferentially dysplastic superior division of the M2 branch, with a new 5 × 4–mm saccular aneurysm distinct from the first, with 2 smaller aneurysms distal to the new ruptured aneurysm. Endovascular parent vessel occlusion with Onyx was performed. Genetic testing revealed a mutation of the MYH11. To the authors' knowledge, this is the first report of rapid de novo aneurysm formation in an infant with an MYH11 mutation. The authors review the patient's clinical presentation and management and comprehensively review the literature on this topic.

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Pediatric Intracranial Aneurysms: New and Enlarging Aneurysms after Index Aneurysm Treatment or Observation

Cited by 37 publications

References 24 publications

De Novo and Recurrent Aneurysms in Pediatric Patients With Cerebral Aneurysms

De Novo and Recurrent Aneurysms in Pediatric Patients With Cerebral Aneurysms

Radiological Changes in Infantile Dissecting Anterior Communicating Artery Aneurysm Treated Endovascularly

Rapid de novo aneurysm formation after clipping of a ruptured middle cerebral artery aneurysm in an infant with an MYH11 mutation

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