Reported incidence and treatment modalities of giant cerebral aneurysms in the pediatric population: A systematic review and illustrative case report

O’Neal, Christen M.; Ernst, Griffin; Hughes, Kendall L.; Stephens, Tressie M.; Hendrix, Madeline C.; Gross, Naina L.; Bohnstedt, Bradley N.; Cheema, Ahmed A.

doi:10.1016/j.jocn.2021.03.045

Cited by 3 publications

(3 citation statements)

References 39 publications

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“…The Identification of the Specific Complexity Profile [ 2 , 19 , 30 ] is determined by the combination of major and minor complexity criteria. Major criteria include fusiform shape, large/giant size, vessel originating from the sac, intrasaccular thrombi [ 3 ], and previous treatments [ 6 , 7 , 8 ]. Minor criteria encompass wide neck, proximal vessel tortuosity, and wall calcification.…”

Section: Discussionmentioning

confidence: 99%

“…The unruptured intracranial aneurysm score (UIATS) defines the aneurysmal complexity given the presence of a neck wider than the diameter of the parent vessel, calcified dome or proximal vessel tortuosity/stenosis, aneurysm thrombosis, or sac smaller than 3 mm [ 3 , 4 , 5 ]. Giant aneurysms and cases with a previous endovascular or surgical treatment can be likewise considered complex [ 4 , 6 , 7 , 8 ]. The Berlin classification emphasizes this concept in MCA aneurysms, driving best management practices in thrombosed aneurysms [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Navigating Complexity: A Comprehensive Approach to Middle Cerebral Artery Aneurysms

Auricchio,

Di Bonaventura,

Marchese

et al. 2024

JCM

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Background: The concept of aneurysm “complexity” has undergone significant changes in recent years, with advancements in endovascular treatments. However, surgical clipping remains a relevant option for middle cerebral artery (MCA) aneurysms. Hence, the classical criteria used to define surgically complex MCA aneurysms require updating. Our objective is to review our institutional series, considering the impacts of various complexity features, and provide a treatment strategy algorithm. Methods: We conducted a retrospective review of our institutional experience with “complex MCA” aneurysms and analyzed single aneurysmal-related factors influencing treatment decisions. Results: We identified 14 complex cases, each exhibiting at least two complexity criteria, including fusiform shape (57%), large size (35%), giant size (21%), vessel branching from the sac (50%), intrasaccular thrombi (35%), and previous clipping/coiling (14%). In 92% of cases, the aneurysm had a wide neck, and 28% exhibited tortuosity or stenosis of proximal vessels. Conclusions: The optimal management of complex MCA aneurysms depends on a decision-making algorithm that considers various complexity criteria. In a modern medical setting, this process helps clarify the choice of treatment strategy, which should be tailored to factors such as aneurysm morphology and patient characteristics, including a combination of endovascular and surgical techniques.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Navigating Complexity: A Comprehensive Approach to Middle Cerebral Artery Aneurysms

Auricchio,

Di Bonaventura,

Marchese

et al. 2024

JCM

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“…Unlike saccular aneurysms, the treatment of dissecting aneurysms requires either surgical excision of the aneurysm or endovascular parent vessel occlusion. While this may be tolerated if the aneurysm is located in a distal, non-eloquent vessel, a more proximal location of the aneurysm often requires a bypass procedure before parent vessel sacrifice [5,7,25,55]. Alternatively, the option of parent artery reconstruction with flow diversion has been described in selected case reports and series [36,56,57].…”

Section: Aneurysm Morphology and Management Outcomes: Our Institution...mentioning

confidence: 99%

Pediatric Intracranial Aneurysms: Experience from a Singapore Children’s Hospital

Chua,

Cheong,

Kirollos

et al. 2024

Surgeries

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(1) Background: Pediatric intracranial aneurysms (PIA) are rare and clinicopathologically distinct neurovascular entities. The aims of this study are to evaluate our institution’s experience and corroborate our results with updated literature. (2) Methods: This is a single-institution, retrospective study. Patients with a confirmed diagnosis of PIA are included. Variables of interest include patient demographics, clinical presentation, treatment outcomes and features specific to each patient’s PIA. A literature review on PIA-centric clinical studies was conducted. (3) Results: A total of 14 PIAs in 11 patients were treated from 2000 to 2022. The mean age was 5.8 years old, and most were males (90.1%). Anterior circulation PIAs constituted 78.6% of the cohort. Half of the PIAs were of the dissecting type, and 14.3% were giant aneurysms. Of interest, 14.3% of patients had subsequent de novo aneurysms after treatment of their index aneurysm. For treatment, 57.1% underwent surgery, 35.7% had endovascular intervention and the remaining 7.1% were managed conservatively. Based on the literature review, this study had congruent findings to other existing publications. (4) Conclusions: PIAs are unique neurovascular lesions that have good outcomes if managed in a timely fashion by an experienced multidisciplinary team. We recommend longer surveillance periods due to the risk of developing de novo aneurysms.

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Saccular intracranial neonatal aneurysm

Massa

Montivero²,

Ciraolo³

et al. 2022

Childs Nerv Syst

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Reported incidence and treatment modalities of giant cerebral aneurysms in the pediatric population: A systematic review and illustrative case report

Cited by 3 publications

References 39 publications

Navigating Complexity: A Comprehensive Approach to Middle Cerebral Artery Aneurysms

Navigating Complexity: A Comprehensive Approach to Middle Cerebral Artery Aneurysms

Pediatric Intracranial Aneurysms: Experience from a Singapore Children’s Hospital

Saccular intracranial neonatal aneurysm

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