Skip to main content

Advertisement

SpringerLink
Log in

Traumatic intracranial aneurysms (TICA) in children: a description of two clinical cases of successful treatment and review of literature

  • Case-Based Review
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Objective

Traumatic intracranial aneurysms (TICA) across all age groups make up less than 1% of all aneurysms. Traumatic aneurysms in children occur from 10 to 39%, and their treatment requires special considerations. Even though readily diagnosed, the management of traumatic intracranial aneurysms in children is still a subject for discussion. Two cases of traumatic aneurysms following penetrating and blunt trauma are presented.

Case description

Two cases of traumatic aneurysms are presented. The first patient presented with an aneurysm of the distal M4 segment of the left middle cerebral artery (MCA) 1 week following blunt traumatic brain injury with skull fractures. The aneurysm was excised without complications. The second patient presented with a saccular aneurysm of the A2 segment of the left anterior cerebral artery (ACA) following penetrating traumatic brain injury with a metal rod. The aneurysm was discovered incidentally on computed tomography angiography (CTA) performed to exclude a brain abscess when the patient developed a persistent fever. After numerous unsuccessful attempts at endovascular embolization, microsurgical aneurysm clipping was performed without complications.

Conclusion

Traumatic intracerebral aneurysms are relatively more common in childhood. They commonly occur in the first 21 days post-trauma but can also occur in the late period. We, therefore, recommend that CTA or direct cerebral angiography should be performed within the first 3 weeks to exclude TICA and in all patients with sudden deterioration in the early postoperative period. Considering the high mortality rate associated with conservative management, surgical and/or endovascular management should be performed once the diagnosis is made.

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

Abbreviations

TICA:

Traumatic intracranial aneurysms

CTA:

Computer tomography angiography

MCA:

Middle cerebral artery

ACA:

Anterior cerebral artery

MRI:

Magnetic resonance imaging

MRA:

Magnetic resonance angiography

References

  1. Gmlcf DL (1980) Iraci G. Intracranial aneurysms of childhood Childs Brain 6:295–302

    Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  4. Parkinson D, West M (1980) Traumatic intracranial aneurysms. J Neurosurg 52(1):11–20

    Article  CAS  PubMed  Google Scholar 

  5. Pasqualin A, Mazza C, Cavazzani P, Scienza R, DaPian R (1986) Intracranial aneurysms and subarachnoid hemorrhage in children and adolescents. Child’s Nervous System 2(4):185–190

    Article  CAS  PubMed  Google Scholar 

  6. 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

    Article  CAS  PubMed  Google Scholar 

  7. Roche J, Choux M, Czorny A, Dhellemmes P, Fast M, Frerebeau P et al (1988) Intracranial arterial aneurysm in children. A cooperative study. Apropos of 43 cases. Neuro-chirurgie 34(4):243–51

  8. Sedzimir CB, Robinson J (1973) Intracranial hemorrhage in children and adolescents. J Neurosurg 38(3):269–281

    Article  CAS  PubMed  Google Scholar 

  9. Benoit BG, Wortzman G (1973) Traumatic cerebral aneurysms: clinical features and natural history. J Neurol Neurosurg Psychiatry 36(1):127–138

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Eliava SS, Yakovlev SB, Pilipenko YV, Konovalov AN, Mikeladze KG, Grebenev FV et al (2021) Unruptured asymptomatic brain aneurysms: modern approaches to the choice of surgical method and treatment outcomes. Zh Vopr Neirokhir Im N N Burdenko 85(6):6–13

    Article  PubMed  Google Scholar 

  11. Larson PS, Reisner A, Morassutti DJ, Abdulhadi B, Harpring JE (2000) Traumatic intracranial aneurysms. Neurosurg Focus 8(1):1–6

    Article  Google Scholar 

  12. Emanuelson I, Wendt LV (1997) Epidemiology of traumatic brain injury in children and adolescents in south-western Sweden. Acta Paediatr 86(7):730–735

    Article  CAS  PubMed  Google Scholar 

  13. Hennes H, Lee M, Smith D, Sty JR, Losek J (1988) Clinical predictors of severe head trauma in children. Am J Dis Child 142(10):1045–1047

    CAS  PubMed  Google Scholar 

  14. Kraus JF, Fife D, Cox P, Ramstein K, Conroy C (1986) Incidence, severity, and external causes of pediatric brain injury. Am J Dis Child 140(7):687–693

    CAS  PubMed  Google Scholar 

  15. Rivara FP (1994) Epidemiology and prevention of pediatric traumatic brain injury. Pediatr Ann 23(1):12–17

    Article  CAS  PubMed  Google Scholar 

  16. Muballe KD, Hardcastle T, Kiratu E (2016) Neurological findings in pediatric penetrating head injury at a university teaching hospital in Durban, South Africa: a 23-year retrospective study. J Neurosurg Pediatr 18(5):550–557

    Article  PubMed  Google Scholar 

  17. Buckingham MJ, Crone KR, Ball WS, Tomsick TA, Berger TS, Tew JM Jr (1988) Traumatic intracranial aneurysms in childhood: two cases and a review of the literature. Neurosurgery 22(2):398–408

    Article  CAS  PubMed  Google Scholar 

  18. Ogilvy C, Ojemann R, Crowell R, Heros R (1995) Paraclinoid carotid aneurysms. Williams & Wilkins, Surgical management of neurovascular disease Baltimore, pp 185–213

    Google Scholar 

  19. Cohen JE, Gomori JM, Segal R, Spivak A, Margolin E, Sviri G et al (2008) Results of endovascular treatment of traumatic intracranial aneurysms. Neurosurgery 63(3):476–486

    Article  PubMed  Google Scholar 

  20. 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 

  21. Sanai N, Quinones-Hinojosa A, Gupta NM, Perry V, Sun PP, Wilson CB et al (2006) Pediatric intracranial aneurysms: durability of treatment following microsurgical and endovascular management. J Neurosurg Pediatr 104(2):82–89

    Article  Google Scholar 

  22. Smith S (1873) ART. IV.--On the difficulties attending the diagnosis of aneurism, being a contribution to surgical diagnosis and to medical jurisprudence. Am J Med Sci (1827–1924). 1873(132):401.

  23. Piatt JH, Clunie DA (1992) Intracranial arterial aneurysm due to birth trauma: case report. J Neurosurg 77(5):799–803

    Article  PubMed  Google Scholar 

  24. Rana AK, Koumellis P, Jaspan T, Cartmill M, Mcconachie NS (2007) Coil embolization of ruptured middle cerebral artery aneurysms in the first 2 months of life: report of two cases. J Neurosurg Pediatr 107(3):232–235

    Article  Google Scholar 

  25. Holmes B, Harbaugh RE (1993) Traumatic intracranial aneurysms: a contemporary review. J Trauma 35(6):855–860

    Article  CAS  PubMed  Google Scholar 

  26. Fox JL (2012) Intracranial aneurysms: volume 1: Springer Science & Business Media

  27. Pozzati E, Gaist G, Servadei F (1982) Traumatic aneurysms of the supraclinoid internal carotid artery: report of two cases. J Neurosurg 57(3):418–422

    Article  CAS  PubMed  Google Scholar 

  28. Yonas H, Dujovny M (1980) “True” traumatic aneurysm of the intracranial internal carotid artery: case report. Neurosurgery 7(5):499–502

    Article  CAS  PubMed  Google Scholar 

  29. Liang W, Xiaofeng Y, Weiguo L, Wusi Q, Gang S, Xuesheng Z (2007) Traumatic carotid cavernous fistula accompanying basilar skull fracture: a study on the incidence of traumatic carotid cavernous fistula in the patients with basilar skull fracture and the prognostic analysis about traumatic carotid cavernous fistula. J Trauma Acute Care Surg 63(5):1014–1020

    Article  Google Scholar 

  30. Dial DL, Maurer GB (1937) Intracranial aneurysms: report of 13 cases. The American Journal of Surgery 35(1):2–21

    Article  Google Scholar 

  31. Paul GA, Shaw C-M, Wray LM (1980) True traumatic aneurysm of the vertebral artery: case report. J Neurosurg 53(1):101–105

    Article  CAS  PubMed  Google Scholar 

  32. Hejrati N, Ebel F, Guzman R, Soleman J (2020) Posttraumatic cerebrovascular injuries in children. A systematic review Child’s nervous system 36(2):251–262

    Article  PubMed  Google Scholar 

  33. Grover PJ, Harris L, Qureshi AM, Rennie A, Robertson F, James G (2021) Occult posterior inferior cerebellar artery dissection requiring endovascular treatment following pediatric head trauma: case report. J Neurosurg Pediatr 27(6):643–648

    Article  PubMed  Google Scholar 

  34. Kieck CF, de Villiers JC (1984) Vascular lesions due to transcranial stab wounds. J Neurosurg 60(1):42–46

    Article  CAS  PubMed  Google Scholar 

  35. Kumar M, Kitchen ND (1998) Infective and traumatic aneurysms. Neurosurg Clin N Am 9(3):577–586

    Article  CAS  PubMed  Google Scholar 

  36. Aarabi B (1988) Traumatic aneurysms of brain due to high velocity missile head wounds. Neurosurgery 22(6 Pt 1):1056–1063

    Article  CAS  PubMed  Google Scholar 

  37. 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 

  38. Fleischer A, Patton J, Tindall G (1975) Cerebral aneurysms of traumatic origin. Surg Neurol 4(2):233–239

    CAS  PubMed  Google Scholar 

  39. Martin NA (1998) The combination of endovascular and surgical techniques for the treatment of intracranial aneurysms. Neurosurg Clin N Am 9(4):897–916

    Article  CAS  PubMed  Google Scholar 

  40. Kakarla UK, Beres EJ, Ponce FA, Chang SW, Deshmukh VR, Bambakidis NC et al (2010) Microsurgical treatment of pediatric intracranial aneurysms: long-term angiographic and clinical outcomes. Neurosurgery 67(2):237–250

    Article  PubMed  Google Scholar 

  41. Watridge CB, Muhlbauer MS, Lowery RD (1989) Traumatic carotid artery dissection: diagnosis and treatment. J Neurosurg 71(6):854–857

    Article  CAS  PubMed  Google Scholar 

  42. Egemen E, Massimi L, Di Rocco C (2012) Latrogenic intracranial aneurysms in childhood: case-based update. Childs Nerv Syst 28(12):1997–2004

    Article  PubMed  Google Scholar 

  43. Chen R, Zhang S, Xiao A, Guo R, Ma J (2021) Risk factors for intracranial aneurysm rupture in pediatric patients. Acta Neurochirurgica 1–8

Download references

Acknowledgements

The publication was carried out with the support of the Peoples Friendship University of Russia (RUDN) strategic academic leadership program.

Author information

Authors and Affiliations

  1. Moscow State Budgetary Healthcare Institution, Morozov Children’s City Clinical Hospital of the Moscow City Healthcare Department, Moscow, Russia

    I. Matvey Livshits, B. Farkhad Berdinov, E. Gennady Chmutin, V. Alexander Levov, G. Kirill Chmutin & U. Zokirzhon Zokhidov

  2. Peoples Friendship University of Russia, RUDN University), 6 Miklukho-Maklaya St, Moscow, 117198, Russian Federation

    B. Farkhad Berdinov, Gerald Musa, E. Gennady Chmutin, G. Kirill Chmutin & U. Zokirzhon Zokhidov

Authors
  1. I. Matvey Livshits
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Farkhad Berdinov
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gerald Musa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Gennady Chmutin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. V. Alexander Levov
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Kirill Chmutin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. U. Zokirzhon Zokhidov
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors read and approved the final manuscript.

Corresponding author

Correspondence to B. Farkhad Berdinov.

Ethics declarations

Ethics approval and consent to participate

Written informed consent was obtained from the patients’ caregivers.

Consent for publication

The authors declare that they have no competing interests.

Conflict of interest

The authors declare that they have no competing interests.

Additional information

Publisher's Note

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

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Livshits, I.M., Berdinov, B.F., Musa, G. et al. Traumatic intracranial aneurysms (TICA) in children: a description of two clinical cases of successful treatment and review of literature. Childs Nerv Syst 38, 2063–2070 (2022). https://doi.org/10.1007/s00381-022-05647-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-022-05647-9

Keywords

Search

Navigation