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Child's Nervous System

, 25:317 | Cite as

The clinical features and treatment of pediatric intracranial aneurysm

  • Jiantao Liang
  • Yuhai Bao
  • Hongqi Zhang
  • Karsten Henning Wrede
  • Xinglong Zhi
  • Meng Li
  • Feng LingEmail author
Original Paper

Abstract

Purpose

Intracranial aneurysms are relatively rare in the pediatric population. The objective of this study was to highlight the clinical and radiological features and the therapeutic outcome and clarify the choice of therapeutic strategies for pediatric intracranial aneurysms.

Materials and methods

Twenty-four consecutive children (age ≤14 years) who were diagnosed and treated for intracranial aneurysms in our institute in the last 23 years were included in this study.

Results

There were nine (36%) patients with posterior circulation aneurysms and eight (32%) with giant aneurysms. Eleven (46%) patients presented with subarachnoid hemorrhage. Fifteen patients underwent endovascular treatment, and four received microsurgical therapy. Five patients were treated conservatively. Ninety-two percent (n = 22) of the patients showed favorable outcomes.

Conclusions

Pediatric intracranial aneurysms differ in many ways from those in adults: male predominance; high incidence of giant, dissecting, and fusiform aneurysms; high incidence of aneurysms in the posterior circulation; high incidence of spontaneous thrombosis; better Hunt–Hess grades at presentation; and better therapeutic outcome. For children with intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. For many complex aneurysms, endovascular therapy was the best choice.

Keywords

Pediatric Aneurysm Intracranial Outcome Therapy 

References

  1. 1.
    Gerosa M, Licata C, Fiore DL, Iraci G (1980) Intracranial aneurysms of childhood. Childs Brain 6:295–302PubMedCrossRefGoogle Scholar
  2. 2.
    Meyer FB, Sundt Jr TM, Fode NC, Morgan MK, Forbes GS, Mellinger JF (1989) Cerebral aneurysms in childhood and adolescence. J Neurosurg 70:420–425PubMedGoogle Scholar
  3. 3.
    Ostergaard JR, Voldby B (1983) Intracranial arterial aneurysms in children and adolescents. J Neurosurg 58:832–837PubMedGoogle Scholar
  4. 4.
    Vaid VK, Kumar R, Kalra SK, Mahapatra AK, Jain VK (2008) Pediatric intracranial aneurysms: an institutional experience. Pediatr Neurosurg 44:296–301PubMedCrossRefGoogle Scholar
  5. 5.
    International study of Unruptured Intracranial Aneurysms Investigators (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103–110CrossRefGoogle Scholar
  6. 6.
    Lasjaunias PL, Campi A, Rodesch G, Alvarez H, Kanaan I, Taylor W (1997) Aneurysmal disease in children. Review of 20 cases with intracranial arterial localisations. Interv Neuroradiol 3:215–229Google Scholar
  7. 7.
    Allison JW, Davis PC, Sato Y, James CA, Haque SS, Angtuaco EJC, Glasier CM (1998) Intracranial aneurysms in infants and children. Pediatr Radiol 28:223–229PubMedCrossRefGoogle Scholar
  8. 8.
    Agid R, Souza MP, Reintamm G et al (2005) The role of endovascular treatment for pediatric aneurysms. Childs Nerv Syst 21:1030–1036PubMedCrossRefGoogle Scholar
  9. 9.
    Sekhar LN, Heros RC (1981) Origin, growth, and rupture of saccular aneurysms: a review. Neurosurgery 8:248–260PubMedCrossRefGoogle Scholar
  10. 10.
    Stehbens WE (1989) Etiology of intracranial berry aneurysms. J Neurosurg 70:823–831PubMedCrossRefGoogle Scholar
  11. 11.
    Huang J, McGirt MJ, Gailloud P, Tamargo RJ (2005) Intracranial aneurysms in the pediatric population case series and literature review. Surg Neurol 63:424–432 discussion 432–433PubMedCrossRefGoogle Scholar
  12. 12.
    Sanai N, Quinones-Hinojosa A, Gupta NM, Perry V, Sun PP, Wilson CB, Lawton MT (2006) Pediatric intracranial aneurysms: durability of treatment following microsurgical and endovascular management. J Neurosurg; 104(suppl 2):82–89PubMedGoogle Scholar
  13. 13.
    Proust F, Toussaint P, Garnieri J, Hannequin D, Legars D, Houtteville JP, Freger P (2001) Pediatric cerebral aneurysms. J Neurosurg 94:733–739PubMedGoogle Scholar
  14. 14.
    Sharma BS, Sinha S, Mehta VS, Suri A, Gupta A, Mahapatra A (2007) Pediatric intracranial aneurysms—clinical characteristics and outcome of surgical treatment. Childs Nerv Syst 23:327–333PubMedCrossRefGoogle Scholar
  15. 15.
    Pasqualin A, Mazza C, Cavazzani P, Scienza R, Da Pian R (1986) Intracranial aneurysms and subarachnoid hemorrhage in children and adolescents. Childs Nerv Syst 2:185–190PubMedCrossRefGoogle Scholar
  16. 16.
    Ostergaard JR (1991) Aetiology of intracranial saccular aneurysms in childhood. Br J Neurosurg 5:575–580PubMedCrossRefGoogle Scholar
  17. 17.
    Menon G, Furtado SV, Nair S (2005) Intracranial arterial aneurysms in children and adolescents. Indian J Cerebrovasc Surg 1:80–84Google Scholar
  18. 18.
    Ferrante L, Fortuna A, Celli P (1988) Intracranial arterial aneurysms in early childhood. Surg Neurol 29:39–56PubMedCrossRefGoogle Scholar
  19. 19.
    Herman JM, Rekate HL, Spetzler RF (1991–1992) Pediatric intracranial aneurysms: simple and complex cases. Pediatr Neurosurg 17:66–73CrossRefGoogle Scholar
  20. 20.
    Lazinski D, Willinsky R, ter Brugge KG, Montanera W (2000) Dissecting aneurysms of the posterior cerebral artery: angioarchitecture and a review of the literature. Neuroradiology 42:128–133PubMedCrossRefGoogle Scholar
  21. 21.
    Massimi L, Moret J, Tamburrini G, Di Rocco C (2003) Dissecting giant vertebro-basilar aneurysms. Childs Nerv Syst 19:204–210PubMedCrossRefGoogle Scholar
  22. 22.
    International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2002) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2,143 patients with ruptured intracranial aneurysms: a randomized trial. Lancet 360:1267–1274CrossRefGoogle Scholar
  23. 23.
    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 21:437–450PubMedCrossRefGoogle Scholar
  24. 24.
    Agid R, Jonas Kimchi T, Lee SK, Ter Brugge KG (2007) Diagnostic characteristics and management of intracranial aneurysms in children. Neuroimaging Clin North Am 17:153–163CrossRefGoogle Scholar
  25. 25.
    Cohen JE, Ferrario A, Caratto R, Miranda C, Lylyk P (2003) Reconstructive endovascular approach for cavernous aneurysm in infancy. Neurol Res 25:492–496PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Jiantao Liang
    • 1
    • 2
  • Yuhai Bao
    • 1
    • 2
  • Hongqi Zhang
    • 1
    • 2
  • Karsten Henning Wrede
    • 2
    • 3
  • Xinglong Zhi
    • 1
    • 2
  • Meng Li
    • 1
    • 2
  • Feng Ling
    • 1
    • 2
    Email author
  1. 1.Cerebrovascular Diseases Research InstituteCapital Medical UniversityBeijingChina
  2. 2.Department of NeurosurgeryXuanwu Hospital of Capital Medical UniversityBeijingChina
  3. 3.International Neuroscience InstituteHannoverGermany

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