Skip to main content

Advertisement

SpringerLink
Log in

Paediatric dissecting posterior cerebral aneurysms: report of two cases and review of the literature

  • INTERVENTIONAL NEURORADIOLOGY
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

Intracranial aneurysms in the paediatric population are uncommon, accounting for 2% to 6% of all aneurysms, and spontaneous arterial dissection is rarely reported as the cause of aneurysms in children, especially in the posterior cerebral artery.

Methods

Two cases of paediatric spontaneous posterior cerebral artery dissecting aneurysms are reported, one in a 33-month-old male child presenting with aneurysmal rupture and subarachnoid haemorrhage and the other in a 9-year-old boy with an unruptured aneurysm.

Results

The first child was successfully treated by endovascular parent vessel occlusion without neurological deficit and in the second a spontaneous thrombosis of the aneurysm and its parent artery occurred associated with hydrocephalus and a favourable outcome.

Conclusion

Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and close follow-up and/or early treatment is warranted. Spontaneous arterial dissection is a rare, probably still under-recognized, cause of intracranial aneurysms that may be responsible for a significant number of aneurysms and spontaneous aneurysmal thromboses in children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Lasjaunias P (ed) (1997) Vascular diseases in neonates, infants and children. Springer, Berlin Heidelberg New York, pp 373–392

    Google Scholar 

  2. McDonald PJ, Wallace MC (2003) Pediatric intracranial aneurysms. In: Leroux P, Winn HR, Newell D (eds) Management of cerebral aneurysms. Saunders, Philadelphia, pp 357–362

    Google Scholar 

  3. Huang J, McGirt M, Gailloud P, Tamargo R (2005) Intracranial aneurysms in the pediatric population: case series and literature review. Surg Neurol 63:424–433

    Article  PubMed  Google Scholar 

  4. Lasjaunias P, Wuppalapati S, Alvarez H et al (2005) Intracranial aneurysms in children aged under 15 years: review of 59 consecutive children with 75 aneurysms. Childs Nerv Syst 21:437–450

    Article  PubMed  Google Scholar 

  5. Ostergaard JR, Voldby B (1983) Intracranial arterial aneurysms in children and adolescents. J Neurosurg 58(6):832–837

    PubMed  CAS  Google Scholar 

  6. Meyer FB, Sundt TM Jr, Fode NC, Morgan MK, Forbes GS, Mellinger JF (1989) Cerebral aneurysms in childhood and adolescence. J Neurosurg 70(3):420–425

    PubMed  CAS  Google Scholar 

  7. Patel AN, Richardson AE (1971) Ruptured intracranial aneurysms in the first two decades of life. A study of 58 patients. J Neurosurg 35(5):571–576

    PubMed  CAS  Google Scholar 

  8. Putty TK, Luerssen TG, Campbell RL, Boaz JC, Edwards MK (1990–1991) Magnetic resonance imaging diagnosis of a cerebral aneurysm in an infant. Case report and review of the literature. Pediatr Neurosurg 16:48–51

    Article  Google Scholar 

  9. Locksley HB, Sahs AL, Knowler L (1966) Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section V, part I. natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the cooperative study. J Neurosurg 25:219–239

    PubMed  CAS  Google Scholar 

  10. Weir BK, Macdonald RL (1996) Intracranial aneurysms and subarachnoid hemorrhage: an overview. In: Wilkins RR, Rengachary SA (eds) Neurosurgery. New York, McGraw-Hill, pp 2191–2213

    Google Scholar 

  11. Allison JW, Davis PC, Sato Y, James CA, Haque SS, Angtuaco EJ, Glasier CM (1998) Intracranial aneurysms in infants and children. Pediatr Radiol 28(4):223–229

    Article  PubMed  CAS  Google Scholar 

  12. Schievink WI, Mokri B, Piepgras DG (1994) Spontaneous dissections of cervicocephalic arteries in childhood and adolescence. Neurology 44(9):1607–1612

    PubMed  CAS  Google Scholar 

  13. Ganesan V, Chong WK, Cox TC, Chawda SJ, Prengler M, Kirkham FJ (2002) Posterior circulation stroke in childhood: risk factors and recurrence. Neurology 59(10):1552–1556

    PubMed  CAS  Google Scholar 

  14. Fullerton HJ, Johnston SC, Smith WS (2001) Arterial dissection and stroke in children. Neurology 57(7):1155–1160

    PubMed  CAS  Google Scholar 

  15. Vilela P, Goulão A (2003) Cervical and intracranial arterial dissection: review of the acute clinical presentation and imaging of 48 cases. Acta Med Port 16(3):155–164

    PubMed  Google Scholar 

  16. Laughlin S, terBrugge K, Willinsky R et al (1997) Endovascular management of pediatric aneurysms. Intervent Neuroradiol 3:205–214

    Google Scholar 

  17. Berenstein A, Lasjaunias P, terBrugge K (eds) (2001) Surgical neuroangiography: clinical and endovascular treatment aspects in adults. Springer, Berlin Heidelberg New York, pp 365–564

    Google Scholar 

  18. Sasaki O, Koizumi T, Ito Y, Sorimachi T, Koike T, Tanaka R (1992) Dissecting aneurysm of the posterior cerebral artery treated with proximal ligation. Surg Neurol 37(5):394–401

    Article  PubMed  CAS  Google Scholar 

  19. Kitanaka C, Tanaka J, Kuwahara M, Teraoka A, Sasaki T, Takakura K, Tanaki J (1994) Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography. J Neurosurg 80(4):667–674

    PubMed  CAS  Google Scholar 

  20. Hosoya T, Adachi M, Yamaguchi K, Haku T, Kayama T, Kato T (1999) Clinical and neuroradiology features of intracranial vertebrobasilar dissection. Stroke 30:1083–1090

    PubMed  CAS  Google Scholar 

  21. Massimi L, Moret J, Tamburrini G, Di Rocco C (2003) Dissecting giant vertebro-basilar aneurysms. Childs Nerv Syst 19(4):204–210

    PubMed  Google Scholar 

  22. Naito I, Iwai T, Sasaki T (2002) Management of intracranial vertebral artery dissections initially presenting without subarachnoid hemorrhage. Neurosurgery 51(4):930–937

    Article  PubMed  Google Scholar 

  23. Pozzati E, Padovani R, Fabrizi A, Sabattini L, Gaist G (1991) Benign arterial dissections of the posterior circulation. J Neurosurg 75(1):69–72

    PubMed  CAS  Google Scholar 

  24. Nakatomi H, Nagata K, Kawamoto S, Shiokawa Y (1997) Ruptured dissecting aneurysm as a cause of subarachnoid hemorrhage of unverified etiology. Stroke 28(6):1278–1282

    PubMed  CAS  Google Scholar 

  25. Amacher AL, Drake CG, Ferguson GG (1981) Posterior circulation aneurysms in young people. Neurosurgery 8(3):315–320

    Article  PubMed  CAS  Google Scholar 

  26. Storrs BB, Humphreys RP, Hendrick EB, Hoffman HJ (1982) Intracranial aneurysms in the pediatric age-group. Childs Brain 9(5):358–361

    Article  PubMed  CAS  Google Scholar 

  27. Ferrante L, Acqui M, Trillo G, Lunardi P, Fortuna A (1996) Aneurysms of the posterior cerebral artery: do they present specific characteristics? Acta Neurochir (Wien) 138(7):840–852

    Article  CAS  Google Scholar 

  28. Seoane ER, Tedeschi H, de Oliveira E, Siqueira MG, Calderon GA, Rhoton AL Jr (1997) Management strategies for posterior cerebral artery aneurysms: a proposed new surgical classification. Acta Neurochir (Wien) 139(4):325–331

    Article  CAS  Google Scholar 

  29. Day A, Gaposchkin CG, Yu C, Rivet D, Dacey R (2003) Spontaneous fusiform middle cerebral artery aneurysms: characteristics and a proposed mechanism of formation. J Neurosurg 99:228–240

    PubMed  Google Scholar 

  30. Simpson RK Jr, Parker WD (1986) Distal posterior cerebral artery aneurysm. Case report. J Neurosurg 64(4):669–672

    PubMed  Google Scholar 

  31. Sundt TM (ed) (1990) Surgical techniques for saccular and giant intracranial aneurysms. Williams & Wilkins, Baltimore, pp 198–210

    Google Scholar 

  32. de Sousa AA, Dantas FL, Neto AP, Carvalho GT (1996) Giant posterior cerebral artery aneurysm in a 4-year-old child: case report. Surg Neurol 45(1):31–35

    Article  PubMed  Google Scholar 

  33. Hayman JA, Anderson RM (1996) Dissecting aneurysm of the basilar artery. Med J Aust 2(8):360–361

    Google Scholar 

  34. Schoenberg BS, Mellinger JF, Schoenberg DG (1978) Cerebrovascular disease in infants and children: a study of incidence, clinical features, and survival. Neurology 28(8):763–768

    PubMed  CAS  Google Scholar 

  35. Kim SH, Kosnik E, Madden C, Rusin J, Wack D, Bartkowski H (1997) Cerebellar infarction from a traumatic vertebral artery dissection in a child. Pediatr Neurosurg 27(2):71–77

    Article  PubMed  CAS  Google Scholar 

  36. Silverboard G, Tart R (2000) Cerebrovascular arterial dissection in children and young adults. Semin Pediatr Neurol 7(4):289–300

    Article  PubMed  CAS  Google Scholar 

  37. Ciceri EF, Klucznik RP, Grossman RG, Rose JE, Mawad ME (2001) Aneurysms of the posterior cerebral artery: classification and endovascular treatment. AJNR Am J Neuroradiol 22(1):27–34

    PubMed  CAS  Google Scholar 

  38. Edner G, Forster DM, Steiner L, Bergvall U (1978) Spontaneous healing of intracranial aneurysms after subarachnoid hemorrhage. Case report. J Neurosurg 48(3):450–454

    PubMed  CAS  Google Scholar 

  39. Andrews BT, Edwards MS, Gannon P (1984) Acutely thrombosed aneurysm of the middle cerebral artery presenting as intracranial hemorrhage in a 3-year-old child. Case report. J Neurosurg 60(6):1303–1307

    PubMed  CAS  Google Scholar 

  40. Davila S, Oliver B, Molet J, Bartumeus F (1984) Spontaneous thrombosis of an intracranial aneurysm. Surg Neurol 22(1):29–32

    Article  PubMed  CAS  Google Scholar 

  41. Waga S, Tochio H (1985) Intracranial aneurysm associated with moyamoya disease in childhood. Surg Neurol 23(3):237–243

    Article  PubMed  CAS  Google Scholar 

  42. Choudhury AR, al Amiri NH, al Moutaery KR, Aabed M, Strelling MK (1991) Giant middle cerebral aneurysm presenting as hemiathetosis in a child and its spontaneous thrombosis. Childs Nerv Syst 7(1):59–61

    Article  PubMed  CAS  Google Scholar 

  43. Tanabe M, Inoue Y, Hori T (1991) Spontaneous thrombosis of an aneurysm of the middle cerebral artery with subarachnoid haemorrhage in a 6-year-old child: case report. Neurol Res 13(4):202–204

    PubMed  CAS  Google Scholar 

  44. Maeda K, Usui M, Tsutsumi K, Iijima A (1997) Spontaneous occlusion of a giant basilar tip aneurysm and a basilar artery due to the dissection of both structures: case report. Surg Neurol 48(6):606–609

    Article  PubMed  CAS  Google Scholar 

  45. Loevner LA, Ting TY, Hurst RW, Goldberg HI, Schut L (1998) Spontaneous thrombosis of a basilar artery traumatic aneurysm in a child. AJNR Am J Neuroradiol 19(2):386–388

    PubMed  CAS  Google Scholar 

  46. Moron F, Benndorf G, Akpek S, Dempsy R, Strother CM (2005) Spontaneous thrombosis of a traumatic posterior cerebral artery aneurysm in a child. AJNR Am J Neuroradiol 26(1):58–60

    PubMed  Google Scholar 

  47. Nass R, Hays A, Chutorian A (1982) Intracranial dissecting aneurysms in childhood. Stroke 13(2):204–207

    PubMed  CAS  Google Scholar 

  48. Piske RL, Darwich R, Campos C, Fonseca N et al (1998) Spontaneous resolution of ruptured dissecting PICA aneurysm. Report of two cases. Interv Neuroradiol 4:287–292

    Google Scholar 

  49. Ciceri EF, Lawhead AL, De Simone T, Valvassori L, Boccardi E (2005) Spontaneous partial thrombosis of a basilar artery giant aneurysm in a child. AJNR Am J Neuroradiol 26(1):56–57

    PubMed  Google Scholar 

  50. Black S, German W (1960) Observations of the relationship between the volume and the size of the orifice of the experimental aneurysms. J Neurosurg 17:984–990

    Google Scholar 

  51. Aoki N, Sakai T (1990) Rebleeding from intracranial dissecting aneurysm in the vertebral artery. Stroke 21(11):1628–1631

    PubMed  CAS  Google Scholar 

  52. Yamaura A, Watanabe Y, Saeki N (1990) Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72(2):183–188

    PubMed  CAS  Google Scholar 

  53. Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T (1995) Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36(5):905–911

    Article  PubMed  CAS  Google Scholar 

  54. Kurata A, Ohmomo T, Miyasaka Y, Fujii K, Kan S, Kitahara T (2001) Coil embolization for the treatment of ruptured dissecting vertebral aneurysms. AJNR Am J Neuroradiol 22(1):11–18

    PubMed  CAS  Google Scholar 

  55. Mizutani T, Kojima H, Asamoto S (2004) Healing process for cerebral dissecting aneurysms presenting with subarachnoid hemorrhage. Neurosurgery 54(2):342–347

    Article  PubMed  Google Scholar 

  56. Yamada M, Kitahara T, Kurata A, Fujii K, Miyasaka Y (2004) Intracranial vertebral artery dissection with subarachnoid hemorrhage: clinical characteristics and outcomes in conservatively treated patients. J Neurosurg 101(1):25–30

    PubMed  Google Scholar 

  57. Yoshimoto Y, Wakai S (1997) Unruptured intracranial vertebral artery dissection. Clinical course and serial radiographic imagings. Stroke 28(2):370–374

    PubMed  CAS  Google Scholar 

  58. Terasaka S, Sawamura Y, Kamiyama H, Fukushima T (2000) Surgical approaches for the treatment of aneurysms on the P2 segment of the posterior cerebral artery. Neurosurgery 47(2):359–364

    Article  PubMed  CAS  Google Scholar 

  59. Berger MS, Wilson CB (1984) Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61(5):882–894

    PubMed  CAS  Google Scholar 

  60. Friedman AH, Drake CG (1984) Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60(2):325–334

    PubMed  CAS  Google Scholar 

  61. Yamaura A, Watanabe Y, Saeki N (1990) Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72(2):183–188

    PubMed  CAS  Google Scholar 

  62. Andoh T, Shirakami S, Nakashima T et al (1992) Clinical analysis of a series of vertebral aneurysm cases. Neurosurgery 31:987–993

    Article  PubMed  CAS  Google Scholar 

  63. Steinberg GK, Drake CG, Peerless SJ (1993) Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms. Immediate results and long-term outcome in 201 patients. J Neurosurg 79(2):161–173

    PubMed  CAS  Google Scholar 

  64. Durward QJ (1995) Treatment of vertebral artery dissecting aneurysm by aneurysm trapping and posterior inferior cerebellar artery reimplantation. Case report. J Neurosurg 82(1):137–139

    Article  PubMed  CAS  Google Scholar 

  65. Yamaura I, Tani E, Yokota M, Nakano A, Fukami M, Kaba K, Matsumoto T (1999) Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils. J Neurosurg 90(5):853–856

    PubMed  CAS  Google Scholar 

  66. Solomon R (2000) Discussion on: Terasaka S, Sawamura Y, Kamiyama H, Fukushima T. Surgical approaches for the treatment of aneurysms on the P2 segment of the posterior cerebral artery. Neurosurgery 47(2):365

    Google Scholar 

  67. Taylor C, Kopitnik T, Samson D, Purdy P (2003) Treatment and outcome in 30 patients with posterior cerebral artery aneurysms. J Neurosurg 99:15–22

    PubMed  Google Scholar 

  68. Gerber C, Neil-Dwyer G, Evans B (1993) An alternative surgical approach to aneurysms of the posterior cerebral artery. Neurosurgery 32:928–931

    Article  PubMed  CAS  Google Scholar 

  69. Hallacq P, Piotin M, Moret J (2002) Endovascular occlusion of the posterior cerebral artery for the treatment of p2 segment aneurysms: retrospective review of a 10-year series. AJNR Am J Neuroradiol 23:1128–1136

    PubMed  Google Scholar 

  70. Vishteh A, Smith, Kris A, McDougall C, Spetzler R (1998) Distal posterior cerebral artery revascularization in multimodality management of complex peripheral posterior cerebral artery aneurysms: technical case report. Neurosurgery 43:166–170

    Article  PubMed  CAS  Google Scholar 

  71. Drake CG (1997) Giant posterior cerebral aneurysms: 66 patients. In: Drake CG, Peerless SJ, Hernesniemi JA (eds.) Surgery of vertebrobasilar aneurysms: London, Ontario, Experience on 1767 patients. Springer, Berlin Heidelberg New York, pp 230–248

    Google Scholar 

  72. Zeal AA, Rhoton AL Jr (1978) Microsurgical anatomy of the posterior cerebral artery. J Neurosurg 48:534–559

    PubMed  CAS  Google Scholar 

  73. Fletcher TM, Taveras JM, Pool JL (1959) Cerebral vasospasm in angiography for intracranial aneurysms. Incidence and significance in one hundred consecutive angiograms. Arch Neurol 1:38

    PubMed  CAS  Google Scholar 

  74. Lin JP (1969) Thrombosis of aneurysm of anterior communicating artery. Case report. Acta Radiol 8:74–80

    CAS  Google Scholar 

  75. Spetzler R, Winestock D, Newton H et al (1974) Disappearance and reappearance of cerebral aneurysm in serial arteriograms. Case report. J Neurosurg 41:508–510

    Article  PubMed  CAS  Google Scholar 

  76. Fodstad H, Liliequist B (1979) Spontaneous thrombosis of ruptures intracranial aneurysms during treatment with tranexamic acid (AMCA). Report of three cases. Acta Neurochir 49:129–144

    Article  CAS  Google Scholar 

  77. Atkinson J, Lane J, Colbassani H et al (1993) Spontaneous thrombosis of posterior cerebral artery aneurysm with angiographic reappearance. J Neurosurg 79:434–437

    Article  PubMed  CAS  Google Scholar 

  78. Lee KC, Joo JY, Lee KS, Shin YS (1999) Recanalization of completely thrombosed giant aneurysm: case report. Surg Neurol 51(1):94–98

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest statement

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Neuroradiology Department, Garcia de Orta Hospital, Av. Prof. Torrado Silva. Pragal, 2801-591, Almada, Portugal

    Pedro Vilela & Augusto Goulão

Authors
  1. Pedro Vilela
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Augusto Goulão
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pedro Vilela.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vilela, P., Goulão, A. Paediatric dissecting posterior cerebral aneurysms: report of two cases and review of the literature. Neuroradiology 48, 541–548 (2006). https://doi.org/10.1007/s00234-006-0086-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-006-0086-z

Keywords

Search

Navigation