Skip to main content

Advertisement

SpringerLink
Log in

Intracranial aneurysms in pediatric population: a two-center audit

  • Original Article
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Objective

Intracranial aneurysms (IA) in children are rare, accounting for less than 5% of all IA. Due to their scarcity, the epidemiology is poorly understood and differs from adults in term of clinical presentation, size, location, and origin. Consequently, the treatment strategies are specific and cannot be only based on data from adult series. The aim of our study was to report the characteristics, management, and outcomes of children treated for IA in two university hospitals located in Normandy (France) over the last 17 years and to perform a literature review of this rare pathology.

Methods

This retrospective study included 18 consecutive children (< 18 years old) admitted with cerebral aneurysm treated in two neurosurgery departments in Normandy, from 2001 to 2018. Computerized tomography and cerebral angiography established the diagnosis. Both endovascular and surgical procedures were discussed in all cases. Data focused on clinical condition at admission, characteristics of the IA, choice of the treatment modalities, and complications. The outcome at follow-up is based on Glasgow outcomes scale (GOS) at 1 year.

Results

During the study period, 18 children (mean age: 12.6 years; sex ratio male/female: 2.3) were admitted with 21 IA. Aneurysms had a mean size of 13.6 mm with 4 giant aneurysms and were mostly located in the anterior circulation (16/21). Clinical presentations at onset were sudden symptoms related to a subarachnoid hemorrhage in 13 patients, headaches in 4 patients with giant aneurysm, and asymptomatic in one patient. Among the 13 patients with ruptured IA, 6 presented in poor preoperative condition (Hunt and Hess Grade ≥ 4). Treatment modalities consisted in embolization in 9 patients and surgery in 9 patients including 2 by-pass surgeries in fusiform aneurysms. Complications were similar in the two groups, but two cases of recanalization were observed in the endovascular group. At 1 year of follow-up, 14 children were in good condition (GOS Score > 4) and one died. Three children presented associated IA treated by the same technique as initial aneurysm.

Conclusions

Pediatric aneurysm is a different pathology compared with adults, occurring more frequently in male population with a higher proportion of giant aneurysms and aneurysms located in the internal carotid bifurcation. The use of endovascular techniques has progressed in the last years, but surgery was proposed for half of our population.

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

Similar content being viewed by others

Abbreviations

AC:

anterior circulation

ACA:

Anterior cerebral artery

ACoA:

anterior communicating artery

CT:

Computerized tomography

F:

female

GO:

good outcomes (Glasgow Outcomes Scale ≥ 4)

GOS:

Glasgow Outcomes Scale

HH grading:

Hunt and Hess grading

IA:

Intracerebral aneurysm

ICA:

Internal carotid artery

ICH:

intracerebral hematoma

IVH:

intraventricular hemorrhage

M:

male

MCA:

Middle cerebral artery

mm:

millimeters

PO:

posterior circulation

PCA:

posterior cerebral artery

PICA:

Postero-inferior cerebelar artery

SAH:

Subarachnoid hemorrhage

y:

years

References

  1. Agid R, Jonas Kimchi T, Lee S-K, Ter Brugge KG (2007) Diagnostic characteristics and Management of Intracranial Aneurysms in children. Neuroimaging Clin N Am 17(2):153–163

    Article  PubMed  Google Scholar 

  2. Agid R, Souza MPS, Armstrong D, Dirks P (2005) The Role of Endovascular Treatment for Pediatric Aneurysms. Childs Nerv Syst 21(12):1030–1036

  3. Alawi A, Edgell RC, Elbabaa SK, Callison RC, Khalili YA, Allam H, Alshekhlee A (2014) Treatment of cerebral aneurysms in children: analysis of the kids’ inpatient database. J Neurosurg Pediatr 14(1):23–30

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  5. Amelot A, Saliou G, Benichi S, Alias Q, Boulouis G, Zerah M, Aghakhani N, Ozanne A, Blauwblomme T, Naggara O (2019) Long-term outcomes of cerebral aneurysms in children. Pediatrics 143(6):e20183036

    Article  PubMed  Google Scholar 

  6. Barburoglu XM, Arat XA (2017) Flow Diverters in the Treatment of Pediatric Cerebrovascular Diseases. Am J Neuroradiol 38(1):113–118

  7. Barletta E, Ricci R, Silva RG, Gaspar RML, Araújo JM, Neves MF, de Aquino JB, Barba Belsuzarri T (2018) Fusiform aneurysms: a review from its pathogenesis to treatment options. Surg Neurol Int 9(1):189

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bell AH, Miller SL, Castillo-Melendez M, Malhotra A (2020) The neurovascular unit: effects of brain insults during the perinatal period. Front Neurosci 13:1452

    Article  PubMed  PubMed Central  Google Scholar 

  9. Boulouis G, Blauwblomme T, Hak JF, Benichi S, Kirton A, Meyer P, Chevignard M, Tournier-Lasserve E, Mackay MT, Chabrier S, Cordonnier C, Kossorotoff M, Naggara O (2019) Nontraumatic pediatric Intracerebral hemorrhage. Stroke 50(12):3654–3661

    Article  PubMed  Google Scholar 

  10. Bowers C, Riva-Cambrin J, Couldwell WT (2012) Efficacy of Clip-Wrapping in Treatment of Complex Pediatric Aneurysms. Childs Nerv Syst 28(12):2121–2127

  11. Cebral JR, Mut F, Raschi M, Scrivano E, Ceratto R, Lylyk P, Putman CM (2011) Aneurysm rupture following treatment with flow-diverting stents: computational hemodynamics analysis of treatment. Am J Neuroradiol 32(1):27–33

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Chalouhi N, Ali MS, Jabbour PM, Tjoumakaris SI, Gonzalez LF, Rosenwasser RH, Koch WJ, Dumont AS (2012) Biology of intracranial aneurysms: role of inflammation. J Cereb Blood Flow Metab 32(9):1659–1676

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Chen R, Ren Y, Zhang S, You C, Liu Y (2018) Radiologic characteristics and high risk of seizures in infants with ruptured intracranial aneurysms: case report and review of the literature. World Neurosurg 118:e772–e777

    Article  PubMed  Google Scholar 

  14. Costa E, Vaz G, Finet P, Goffette P, Docquier M, Raftopoulos C (2019) Recanalization and rupture after intracranial aneurysm treatment. J Neurosug Sci 63(5):518–524

    Google Scholar 

  15. Deora H, Rao KVLN, Somanna S, Srinivas D, Shukla DP, Bhat DI (2017) Surgically managed pediatric intracranial aneurysms: how different are they from adult intracranial aneurysms? Pediatr Neurosurg 52(5):313–317

    Article  PubMed  Google Scholar 

  16. Fulkerson DH, Voorhies JM, Payner TD, Leipzig TJ, Horner TG, Redelman K, Cohen-Gadol AA (2011) Middle Cerebral Artery Aneurysms in Children: Case Series and Review: Clinical Article.J Neurosurg Pediatr 8(1):79–89

  17. Gawlitza M, Soize S, Barbe C, le Clainche A, White P, Spelle L, et al (2019) Aneurysm characteristics, study population, and endovascular techniques for the treatment of intracranial aneurysms in a large, prospective, multicenter cohort: results of the analysis of recanalization after endovascular treatment of intracranial aneurysm study. Am J Neuroradio l40(3):517–523

  18. Gemmete JJ, Toma AK, Davagnanam I, Robertson F, Brew S (2013) Pediatric cerebral aneurysms. Neuroimaging Clin N Am 23(4):771–779

    Article  PubMed  Google Scholar 

  19. Goia A, Garrido E, Lefebvre M, Langlois O, Derrey S, Papagiannaki C, Gilard V (2020). Ruptured intracranial aneurysm in a neonate: case report and review of the literature. World Neurosurg 140:219–223

  20. Hayakawa M, Murayama Y, Duckwiler GR, Pierre Gobin Y, Guglielmi G, Viñuela F (2000) Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system. J Neurosurg 93(4):561–568

    Article  CAS  PubMed  Google Scholar 

  21. Heffren J, McIntosh AM, Reiter PD (2015) Nimodipine for the prevention of cerebral vasospasm after subarachnoid hemorrhage in 12 children. Pediatr Neurol 52(3):356–360

    Article  PubMed  Google Scholar 

  22. Hetts SW, Narvid J, Sanai N, Lawton MT, Gupta N, Fullerton HJ, Dowd CF, Higashida RT, Halbach VV (2009) Intracranial aneurysms in childhood: 27-year single-institution experience. Am J Neuroradiol 30(7):1315–1324

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Huang J, McGirt MJ, Gailloud P, Tamargo RJ (2005) Intracranial aneurysms in the pediatric population: case series and literature review. Surg Neurol 63(5):424–432

    Article  PubMed  Google Scholar 

  24. Kakarla UK, Beres EJ, Ponce FA, Chang SW, Deshmukh VR, Bambakidis NC, Zabramski JM, Spetzler RF (2010) Microsurgical treatment of pediatric intracranial aneurysms: long-term angiographic and clinical outcomes. Neurosurgery 67(2):237249

  25. Krishna H, Wani AA, Behari S, Banerjee D, Chhabra DK, Jain VK (2005) Intracranial aneurysms in patients less than or equal to 18 years:are they different from aneurysms in adult population? Acta Neurochirurgica (Wein) 147:469–476

    Article  CAS  Google Scholar 

  26. Koroknay-Pál P, Laakso A, Lehto H, Seppä K, Kivisaari R, Hernesniemi J, Niemelä M (2012) Long-term excess mortality in pediatric patients with cerebral aneurysms. Stroke 43(8):2091–2096

    Article  PubMed  Google Scholar 

  27. Koroknay-Pál P, Lehto H, Niemelä M, Kivisaari R, Hernesniemi J (2012) Long-term outcome of 114 children with cerebral aneurysms. J Neurosurg Pediatr 9(6):636–645

    Article  PubMed  Google Scholar 

  28. Lasjaunias P, Wuppalapati S, Alvarez H, Rodesch G, Ozanne A (2005) Intracranial aneurysms in children aged under 15 years: review of 59 consecutive children with 75 aneurysms. Childs Nerv Syst 21(6):437–450

    Article  PubMed  Google Scholar 

  29. Liang J, Bao Y, Zhang H, Wrede KH, Zhi X, Li M, Ling F (2009) The clinical features and treatment of pediatric intracranial aneurysm. Childs Nerv Syst 25(3):317–324

    Article  PubMed  Google Scholar 

  30. Lv X, Jiang C, Li Y, Yang X, Wu Z (2009) Endovascular Treatment for Pediatric Intracranial Aneurysms. Neuroradiology 51(11):749–754

  31. Mehrotra A, Nair AP, Das KK, Srivastava S, et al. (2012) Clinical and Radiological Profiles and Outcomes in Pediatric Patients with Intracranial Aneurysms. J Neurosurg Pediatr 10(4):340–346

  32. Mohotti JE, Carter NS, Zhang VJW, Lai LT, Xenos C, Asadi H, Chandra RV (2018) Neonatal intracranial aneurysms: case report and review of the literature. J Neurosurg Pediatr 21(5):471–477

    Article  PubMed  Google Scholar 

  33. Molyneux A, Group ISAT (ISAT) C et al (2002) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360(9342):1267–1274

    Article  PubMed  Google Scholar 

  34. Park S-H, Yim M-B, Lee C-Y, Kim E, Son E-I (2008) Intracranial fusiform aneurysms: It’s pathogenesis, clinical characteristics and managements. J Korean Neurosurg Soc 44(3):116–123

    Article  PubMed  PubMed Central  Google Scholar 

  35. Pope FM, Kendall BE, Slapak GI, Kapoor R, McDonald WI, Compston DAS, Mitchell R, Hope DT, Millar-Craig MW, Dean JCS, Johnston AW, Lynch PG, Sarathchandra P, Narcisi P, Nicholls AC, Richards AJ, Mackenzie JL (1991) Type III collagen mutations cause fragile cerebral arteries. Br J Neurosurg 5(6):551–574

    Article  CAS  PubMed  Google Scholar 

  36. Proust F, Toussaint P, Garniéri J, Hannequin D, Legars D, Houtteville J-P, Fréger P (2001) Pediatric cerebral aneurysms. J Neurosurg 94(5):733–739

    Article  CAS  PubMed  Google Scholar 

  37. Pruvot A-S, Curey S, Derrey S, Castel H, Proust F (2016) Giant intracranial aneurysms in the paediatric population: suggested management and a review of the literature. Neurochirurgie 62(1):20–24

    Article  PubMed  Google Scholar 

  38. Regelsberger J, Heese O, Martens T, Ries T, Kunkel P, Westphal M (2009) Intracranial aneurysms in childhood: report of 8 cases and review of the literature. Cent Eur Neurosurg 70(02):79–85

    Article  CAS  PubMed  Google Scholar 

  39. Requejo F, Ceciliano A, Cardenas R, Villasante F, Jaimovich R,Zuccaro G (2010) Cerebral Aneurysms in Children: Are We Talking about a Single Pathological Entity? Childs Nerv Syst 26(10):1329–1335

  40. Saleh E, Dawson RC 3rd (2011). Endovascular Management of Pediatric Aneurysms. Neuroradiol J 24(5):693–698

  41. Saraf R, Shrivastava M, Siddhartha W, Limaye U (2012) Intracranial pediatric aneurysms: endovascular treatment and its outcome. J Neurosurg Pediatr 10(3):230–240

    Article  PubMed  Google Scholar 

  42. Sharma BS, Sinha S, Mehta VS, Suri A, Gupta A, Mahapatra AK (2007) Pediatric intracranial aneurysms—clinical characteristics and outcome of surgical treatment. Childs Nerv Syst 23(3):327–333

    Article  CAS  PubMed  Google Scholar 

  43. Snelling BM, Sur S, Shah SS, Peterson EC (2017) Treatment of Cerebral Vasospasm in an Infant Using a Modified Dotter Technique. J Cerebrovasc Endovasc Neurosurg 19(1):48

    Article  PubMed  PubMed Central  Google Scholar 

  44. Skoch J, Tahir R, Abruzzo T, Taylor JM, Zuccarello M, Vadivelu S (2017) Predicting symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage with an artificial neural network in a pediatric population. Childs Nerv Syst 33(12):2153–2157

    Article  PubMed  Google Scholar 

  45. Song Y, Qian SY, Li Y, Liu J, Li Z, Jia XL, Gao HM, Zeng JS (2019) Effectiveness and safety of nimodipine in preventing cerebral vasospasm after subarachnoid hemorrhage in children. Zhonghua Er Ke Za Zhi 57(5):338–343

    CAS  PubMed  Google Scholar 

  46. Sorteberg A, Dahlberg D (2013) Intracranial non-traumatic aneurysms in children and adolescents. Curr Pediatr Rev 9(4):343–352

    Article  PubMed  PubMed Central  Google Scholar 

  47. Stergaard JR (1983) Intracranial arterial aneurysms in children and adolescents. J Neurosurg 58:6

    Google Scholar 

  48. Stiefel MF, Heuer GG, Basil AK, Weigele JB, Sutton LN, Hurst RW, Storm PB (2008) Endovascular and surgical treatment of ruptured cerebral aneurysms in pediatric patients. Neurosurgery 63(5):859–866

    Article  PubMed  Google Scholar 

  49. Sughrue ME, Saloner D, Rayz VL, Lawton MT (2011) Giant intracranial aneurysms: evolution of Management in a Contemporary Surgical Series. Neurosurgery 69(6):1261–1271

    Article  PubMed  Google Scholar 

  50. Takemoto K, Tateshima S, Golshan A, Gonzalez N, Jahan R, Duckwiler G, Vinuela F (2014) Endovascular Treatment of Pediatric Intracranial Aneurysms: A Retrospective Study of 35 Aneurysms. J Neurointerv Surg 6(6):432–438

  51. Tatli M, Guzel A, Kilincer C, Goksel HM (2008) Pediatric cerebral aneurysms: A report of 9 cases. Cerebral vasospasm 104:411–414

  52. Udomphorn Y, Armstead WM, Vavilala MS (2008) Cerebral blood flow and autoregulation after pediatric traumatic brain injury. Pediatr Neurol 38(4):225–234

    Article  PubMed  PubMed Central  Google Scholar 

  53. Vargas SA, Diaz C, Herrera DA, Dublin AB (2016) Intracranial Aneurysms in Children: The Role of Stenting and Flow-Diversion. J Neuroimaging 26(1):41–45

  54. Vergouwen MDI, Vermeulen M, van Gijn J, Rinkel GJE, Wijdicks EF, Muizelaar JP, Mendelow AD, Juvela S, Yonas H, Terbrugge KG, Macdonald RL, Diringer MN, Broderick JP, Dreier JP, Roos YBWEM (2010) Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke 41(10):2391–2395

    Article  PubMed  Google Scholar 

  55. Vizcaíno-Díaz C, Sánchez-Zaplana H, Carneado Ruiz J, Jiménez-Cobo B (2009) Rupture of intracranial arterial aneurysms in neonates: case report and review of the literature. J Child Neurol 24(2):208–214

    Article  PubMed  Google Scholar 

  56. Wojtacha M, Bażowski P, Mandera M, Krawczyk I, Rudnik A (2001) Cerebral Aneurysms in Childhood. Childs Nerv Syst 17(1–2):37–41

  57. Wu C, Honarmand AR, Schnell S, Kuhn R, Schoeneman SE, Ansari SA, Carr J, Markl M, Shaibani A (2016) Age-Related Changes of Normal Cerebral and Cardiac Blood Flow in Children and Adults Aged 7 Months to 61 Years. J Am Heart Assoc 5(1):e002657

  58. Yang M, Wang S, Zhao Y, Zhao J (2008) Management of Intracranial Aneurysm in children: clipped and coiled. Childs Nerv Syst 24(9):1005–1012

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Yasin JT, Wallace AN, Madaelil TP, Osbun JW, Moran CJ, Cross DT, Limbrick DD, Zipfel GJ, Dacey RG, Kansagra AP (2018) Treatment of Pediatric Intracranial Aneurysms: Case Series and Meta-Analysis. J Neurointerv Surg 11(3):257–264

  60. Zhang Y-S, Wang S, Wang Y, Tian Z-B, Liu J, Wang K, Chen J-F, Yang X-J (2016) Treatment for Spontaneous Intracranial Dissecting Aneurysms in Childhood: A Retrospective Study of 26 Cases. Front Neurol 7:224

Download references

Funding

No funding was received for this research.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France

    Elisabeth Garrido, Olivier Langlois, Sophie Curey, Stéphane Derrey & Vianney Gilard

  2. Department of Neurosurgery, Caen University Hospital, Caen, France

    Thomas Metayer, Alin Borha, Camille Di Palma, Evelyne Emery & Thomas Gaberel

  3. Department of Neuroradiology, Rouen University Hospital, Rouen, France

    Chrysanthi Papagiannaki

  4. Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Normandie Univ, UNIROUEN, INSERM U1245, Rouen, France

    Vianney Gilard

  5. PhIND “Physiopathology and Imaging of Neurological Disorders”, Institut Blood and Brain @ Caen-Normandie, Normandie Univ, UNICAEN, I INSERM, U1237, Cyceron, 14000, Caen, France

    Thomas Metayer, Alin Borha, Evelyne Emery & Thomas Gaberel

Authors
  1. Elisabeth Garrido
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas Metayer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alin Borha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olivier Langlois
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sophie Curey
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chrysanthi Papagiannaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Camille Di Palma
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Evelyne Emery
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Stéphane Derrey
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Thomas Gaberel
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Vianney Gilard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elisabeth Garrido.

Ethics declarations

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Garrido, E., Metayer, T., Borha, A. et al. Intracranial aneurysms in pediatric population: a two-center audit. Childs Nerv Syst 37, 2567–2575 (2021). https://doi.org/10.1007/s00381-021-05151-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-021-05151-6

Keywords

Search

Navigation