Intracranial arterial aneurysms in childhood: case report (original) (raw)

Intracranial aneurysms in the pediatric population: case series and literature review

Surgical Neurology, 2005

Background: Intracranial aneurysms in children ( V 18 years old) are rare, and their epidemiology is poorly understood. We present a prospective 14-year experience at our institution and review the literature to clarify the characteristics and outcomes of pediatric patients with intracranial aneurysms. Methods: Review of medical records in the Johns Hopkins aneurysm prospective database and review of the literature since 1939 were performed. Results: Of 1377 intracranial aneurysm cases at our institution from 1991 to 2004, 19 (1.4%) pediatric patients were treated using microsurgical or endovascular techniques. Male/female ratio was 2.2:1. Eleven percent occurred at the internal carotid artery (ICA) bifurcation, and 42% were located in the posterior circulation. Seven (37%) were giant lesions; 58% presented with subarachnoid hemorrhage. Patients in good Hunt and Hess grade (I-III) comprised 42%, and poor-grade (IV-V) patients comprised 16%. At a mean follow-up duration of 3.0 F 3 years, 95% of patients demonstrated favorable outcomes with Glasgow Outcome Scale score of 4 or 5. In the literature, a total of 706 pediatric intracranial aneurysm cases have been described since 1939. The male/female ratio is 1.8:1. The ICA bifurcation was the location in 26%, and only 17% were in the posterior circulation. Twenty percent were giant lesions, and 80% presented with subarachnoid hemorrhage. Good-and poor-grade patients comprise 49% and 36% of the total cases, respectively. Favorable outcome was reported in 60%. Conclusions: During recent decades, good outcomes after the treatment of ruptured and unruptured pediatric aneurysms have increased, reaching 95% in the current series. Pediatric intracranial aneurysms occur more commonly in male patients and have a predilection for the terminal ICA bifurcation. D

Intracranial arterial aneurysms in children and adolescents

Acta Neurochir, 1981

This is a report on 32 patients with subarachnoid haemorrhage caused by rupture of an intracranial arterial aneurysm in the 0-19 age group. Sixteen of the aneurysms were situated in the bifurcation of the internal carotid artery, 8 in the anterior communicating artery, 4 in the posterior communicating artery, two in PICA, one in the middle cerebral artery, and one in the pericallosal artery.

Intracranial Aneurysms in the Pediatric Population: Case Series

Research Square (Research Square), 2022

Introduction: Aneurysms are rare in the pediatric population and its diagnosis can be challenging. They differ from their adult counterparts in several aspects, and hemorrhage is the most frequent presentation. Objective: To evaluate clinical data, aneurysms characteristics and therapeutic results in a series of patients <18 years of age with intracranial aneurysms. Method: A retrospective cross-sectional observational study design through the analysis of medical records and imaging studies. Analyzed data included age, sex, presentation, comorbidities, aneurysmal characteristics, treatment modality and clinical outcomes. Results: 15 intracranial aneurysms were identi ed in 11 patients (6 male), with ages ranging from 3 months to 15 years (mean 5.2 years). Five patients had associated medical conditions, and hemorrhage was the most frequent clinical presentation (45%). Three patients (27%) had multiple aneurysms, and 7 aneurysms were fusiform or dysplastic. The internal carotid artery was the most affected site, occurring in 47% of cases. Aneurysm size ranged from 2 mm to 60 mm (mean 16.8 mm), with giant aneurysms in 27%. Seven patients were treated via endovascular procedures and three aneurysms were clipped. Symptomatic vasospasm requiring angioplasty occurred in two patients. One patient died due to severe aspiration pneumonia and sepsis that precluded treatment. Good functional outcome (mRS < 2) was achieved in all patients submitted to treatment (91%). Conclusion: The patients with aneurysms in this series were characterized by hemorrhagic presentation, mild male predominance, and internal carotid artery involvement. The outcome of treated patients was favorable, regardless of the treatment modality.

Aneurysms in children: Review of 15 years experience

Journal of Clinical Neuroscience, 2006

Introduction: Intracranial aneurysms in children are rare. The location, size, age, and presentation in the young are markedly different from that of adults. The 15-year experience of the senior author in southern California is presented. Methods: All paediatric patients treated for cerebral aneurysm over a 15-year period were identified. Intraoperative and postoperative data were collected retrospectively from the medical records. The need for additional surgery as well as the incidence of complications including death, hemiparesis, seizures, memory disturbances, and the need for subsequent cerebrospinal fluid (CSF) diversion were identified. Results: Fifty children were identified (54 lesions). Subarachnoid haemorrhage was the most common mode of presentation with the average Hunt-Hess grade being I-II. The locations of the lesions were middle cerebral (10), internal carotid (8), anterior communicating (7), posterior cerebral (6), posterior communicating (5), pericallosal (4), anterior cerebral (3), choroidal (3), posterior inferior cerebellar (3), basilar (2), vertebral (2) and frontopolar (1) arteries. Clinical vasospasm was encountered in eight of our patients, but no cases were observed in those younger than nine years. Long-term outcome was excellent in 22 cases, good in 20 and poor in nine, with one death and two patients lost to follow-up. Conclusion: Analysis of our data suggested a predilection for the posterior circulation compared to adults, larger size, more complex architecture, and a decreased incidence of clinical vasospasm in the younger age group. This series and a review of the literature suggest that aneurysmal disease in children may be distinct from that of adults.

Paediatric intracranial aneurysms: a British institutional review

Child's Nervous System, 2019

Introduction Paediatric intracranial aneurysms are rare, with a differing natural history and thought to account for only up to 7% of all intracranial aneurysms. There is much uncertainty that surrounds the prevalence of unruptured intracranial aneurysms and it is estimated to be anywhere between 2 and 90 per 1000. This is the largest British single-centre analysis of paediatric intracranial aneurysms. We present the patient course from their initial presentations to the outcome of treatment and evaluate a serial assessment of adequacy of aneurysmal obliteration radiologically. Results Twenty-two paediatric cases were identified that required treatment. The median age of presentation was 11.3 years (mean 9.9, range 0 to 15.9), 68% (15/22) were male and 77% (17/22) were ruptured on presentation. The majority of aneurysms were located at the anterior circulation (77% (17/22)). The overall median aneurysm size (n = 21) was 7.4 mm (mean 5 mm, range 2.5-19 mm). Twenty patients survived the acute phase and 80% (16/20) underwent coil embolisation and the other patients' surgical clipping. The overall outcomes were available for the 20 patients; on discharge, 90% (18/20) had a favourable clinical outcome (GOS score of 3-5). Treatment-specific clinical favourable outcomes were 88% (14/16) for coil embolisation against 100% (4/4) after surgical clipping. Of the two patients that died in the acute phase, one had sickle cell anaemia. Aneurysm aetiology was unknown in all other cases. None of the patients had a family history of aneurysms. Conclusion Paediatric intracranial aneurysms while rare should be considered a differential diagnosis of children presenting with unexplained loss of consciousness with or without focal neurological deficit and/or headache. There is a two to one preponderance for males with a larger proportion of aneurysms within the posterior circulation (25%). Coil embolisation is the preferred method of securing a paediatric intracranial aneurysm.

Pediatric Intracranial Aneurysms: An Institutional Experience

Pediatric Neurosurgery, 2008

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 =...

True extracranial carotid artery aneurysm in a child

Journal of Vascular Surgery Cases, 2015

Isolated true aneurysm of the extracranial carotid artery is a rare entity in the pediatric population, with nine reported cases found in the literature. Contrary to adult carotid aneurysms, which are often due to atherosclerotic disease, pediatric aneurysms are more likely to be the result of congenital malformations, connective tissue diseases, or systemic inflammatory conditions. We present the case of a 10-year-old boy with an isolated true aneurysm of the internal carotid artery and a review of the literature.