Ruptured Dissecting Vertebrobasilar Aneurysm in Childhood: What Is the Therapeutic Strategy?

Abstract

Background/Aims: Pediatric aneurysms are rare, accounting for 0.5-4.6% of all intracranial aneurysms. Dissecting vertebrobasilar aneurysms (DVBA) are more frequently observed among children than adults. Cases acutely presenting with subarachnoid hemorrhage need a prompt treatment because of the higher mortality related to untreated cases. Options for an active DVBA management depend on the features of the malformation and include endovascular and surgical approaches. Methods: We refer to an 8-year-old healthy female, who presented with a sudden severe headache and vomit, followed by a half-hour loss of consciousness. A CT scan revealed subarachnoid hemorrhage, and brain MR angiography showed a lesion with mass effect on bulbar structures, suggestive of an aneurysm of the vertebrobasilar junction. The intracranial angiography confirmed this diagnosis and showed a relevant revascularization coming from the anterior cerebral circulation. Results: Endovascular treatment was considered as a suitable option and occlusion of both vertebral arteries, saving the left posterior inferior cerebellar artery, was performed. No neurological deficits appeared after embolization, and the patient was clinically stable at 18 months of follow-up. Conclusion: In the ‘stent era', parent vessel deconstruction throughout endovascular balloon or coil occlusion could be considered in patients with a sound collateral circulation and when cerebellar hemisphere and encephalic trunk feeding is not compromised.

Angiographic morphometry of internal carotid circulation in turkish children

“…Secondary to a gradual increase in the endovascular treatment of aneurysms in pediatric age group (16) as well as recent inclusion of children in intraarterial stroke treatments (3), stents and similar devices (stentrievers, flow diverters) which are used as common (or in certain cases as routine) endovascular devices (1,10), are inevitably finding their use in the pediatric population. In the meantime, concerns have arisen regarding intracranial stent use in the pediatric age group due to unknown effect of stents on growing vessels (3,20,29). Arnold et al (3) implied that stents were contraindicated in children due to ongoing growth as well as the small sizes of the cerebral arteries.…”

Treatment for Spontaneous Intracranial Dissecting Aneurysms in Childhood: A Retrospective Study of 26 Cases

“…Intracranial aneurysms are rare in childhood, and intracranial dissecting aneurysms (IDAs) are even rarer (1, 2). The pediatric patients with an intracranial aneurysm manifested themselves clinically in various manners with hemorrhage, mass effect, or ischemia.…”