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Child's Nervous System

, Volume 26, Issue 10, pp 1309–1318 | Cite as

Pathomechanisms and treatment of pediatric aneurysms

  • Timo KringsEmail author
  • Sasikhan Geibprasert
  • Karel G. terBrugge
Special Annual Issue

Abstract

Pediatric aneurysms are rare diseases distinct from classical adult aneurysms and therefore require different treatment strategies. Apart from saccular aneurysms that are more commonly found in older children, three major pathomechanisms may be encountered: trauma, infection, and dissection. The posterior circulation and more distal locations are more commonly encountered in children compared to adults, and there is an overall male predominance. Clinical findings are not only confined to subarachnoid hemorrhage but may also comprise mass effects, headaches or neurological deficits. In traumatic aneurysms, the skull base and distal anterior communicating artery are commonly affected, and the hemorrhage occurs often delayed (2–4 weeks following the initial trauma). Infectious aneurysms are mostly bacterial in origin, and hemorrhage occurs early after a septic embolic shower. Dissecting aneurysms are the most often encountered aneurysm type in children and can lead to mass effect, hemorrhage, or ischemia depending on the fate of the intramural hematoma. Treatment strategies in pediatric aneurysms include endosaccular coil treatment only for the “classical berry-type” aneurysms; in the other instances, parent vessel occlusion, flow reversal, surgical options, or a combined treatment with bypass and parent vessel occlusion have to be contemplated.

Keywords

Aneurysm Dissection Subarachnoid hemorrhage Infection Trauma 

References

  1. 1.
    Agid R, Souza MP, Reintamm G, Armstrong D, Dirks P, TerBrugge KG (2005) The role of endovascular treatment for pediatric aneurysms. Childs Nerv Syst 21:1030–1036CrossRefPubMedGoogle Scholar
  2. 2.
    Almeida GM, Pindaro J, Plese P, Bianco E, Shibata MK (1977) Intracranial arterial aneurysms in infancy and childhood. Childs Brain 3:193–199PubMedGoogle Scholar
  3. 3.
    Barrow DL, Prats AR (1990) Infectious intracranial aneurysms: comparison of groups with and without endocarditis. Neurosurgery 27:562–572, discussion 572–563CrossRefPubMedGoogle Scholar
  4. 4.
    Bohmfalk GL, Story JL, Wissinger JP, Brown WE Jr (1978) Bacterial intracranial aneurysm. J Neurosurg 48:369–382CrossRefPubMedGoogle Scholar
  5. 5.
    Choux M, Lena G, Genitori L (1992) Intracranial aneurysms in children. In: Raimondi A, Choux M, Di Rocco C (eds) Cerebrovascular disease in children. Springer, Vienna, pp 123–131Google Scholar
  6. 6.
    Clare CE, Barrow DL (1992) Infectious intracranial aneurysms. Neurosurg Clin N Am 3:551–566PubMedGoogle Scholar
  7. 7.
    Hahn YS, Welling B, Reichman OH, Azar-Kia B (1990) Traumatic intracavernous aneurysm in children: massive epistaxis without ophthalmic signs. Childs Nerv Syst 6:360–364CrossRefPubMedGoogle Scholar
  8. 8.
    Herman JM, Rekate HL, Spetzler RF (1991) Pediatric intracranial aneurysms: simple and complex cases. Pediatr Neurosurg 17:66–72, discussion 73CrossRefPubMedGoogle Scholar
  9. 9.
    Hourihan MD, Gates PC, McAllister VL (1984) Subarachnoid hemorrhage in childhood and adolescence. J Neurosurg 60:1163–1166CrossRefPubMedGoogle Scholar
  10. 10.
    Housepian EM, Pool JL (1958) A systematic analysis of intracranial aneurysms from the autopsy file of the Presbyterian Hospital, 1914–1956. J Neuropathol Exp Neurol 17:409–423CrossRefPubMedGoogle Scholar
  11. 11.
    Krings T, Piske RL, Lasjaunias PL (2005) Intracranial arterial aneurysm vasculopathies: targeting the outer vessel wall. Neuroradiology 47:931–937CrossRefPubMedGoogle Scholar
  12. 12.
    Krings T, Alvarez H, Reinacher P, Ozanne A, Baccin CE, Gandolfo C, Zhao WY, Reinges MH, Lasjaunias P (2007) Rupture mechanisms of partially thrombosed aneurysms. Interv Neuroradiol 13:117–126PubMedGoogle Scholar
  13. 13.
    Krings T, Geibprasert S, Pereira V, Lasjaunias P (2008) Aneurysms. In: Naidich T (ed) Neuroradiology of the brain and spine. Elsevier, New York (in press)Google Scholar
  14. 14.
    Krings T, Lasjaunias P, Geibprasert S, Pereira V, Hans FJ (2008) The aneurysmal wall. The key to a subclassification of intracranial arterial aneurysm vasculopathies? Interv Neuroradiol 14:315–329Google Scholar
  15. 15.
    Lasjaunias P (2000) From aneurysm to aneurysmal vasculopathies. Operative Techniques in Neurosurgery 3:160–165CrossRefGoogle Scholar
  16. 16.
    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 21:437–450CrossRefPubMedGoogle Scholar
  17. 17.
    Lasjaunias P, Terbrugge K, Berenstein A (2006) Intracranial aneurysms in children. Surgical neuroangiography part 3: clinical and interventional aspects in children. Springer, Berlin, pp 789–850Google Scholar
  18. 18.
    Locksley HB (1966) Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the cooperative study. J Neurosurg 25:219–239CrossRefPubMedGoogle Scholar
  19. 19.
    Marsot-Dupuch K, Riachi S, Berthet K, Azizi L (2000) Infectious aneurysms of the cavernous carotid artery. J Radiol 81:891–898PubMedGoogle Scholar
  20. 20.
    Mazza C, Pasqualin A, Da Pian R, Pezzotta S (1986) Intracranial aneurysms and subarachnoid hemorrhage in children and adolescents. Minerva Med 77:1145–1151PubMedGoogle Scholar
  21. 21.
    Mizutani T, Miki Y, Kojima H, Suzuki H (1999) Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery 45:253–259, discussion 259–260CrossRefPubMedGoogle Scholar
  22. 22.
    Mizutani T, Kojima H (2000) Clinicopathological features of non-atherosclerotic cerebral arterial trunk aneurysms. Neuropathology 1:91–97CrossRefGoogle Scholar
  23. 23.
    Nakstad P, Nornes H, Hauge HN (1986) Traumatic aneurysms of the pericallosal arteries. Neuroradiology 28:335–338CrossRefPubMedGoogle Scholar
  24. 24.
    Nishioka H (1966) Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section VII. I. Evaluation of the conservative management of ruptured intracranial aneurysms. J Neurosurg 25:574–592CrossRefPubMedGoogle Scholar
  25. 25.
    Ostergaard JR, Voldby B (1983) Intracranial arterial aneurysms in children and adolescents. J Neurosurg 58:832–837CrossRefPubMedGoogle Scholar
  26. 26.
    Ostergaard JR (1991) Aetiology of intracranial saccular aneurysms in childhood. Br J Neurosurg 5:575–580CrossRefPubMedGoogle Scholar
  27. 27.
    Pasqualin A, Mazza C, Cavazzani P, Scienza R, DaPian R (1986) Intracranial aneurysms and subarachnoid hemorrhage in children and adolescents. Childs Nerv Syst 2:185–190CrossRefPubMedGoogle Scholar
  28. 28.
    Patel AN, Richardson AE (1971) Ruptured intracranial aneurysms in the first two decades of life. A study of 58 patients. J Neurosurg 35:571–576CrossRefPubMedGoogle Scholar
  29. 29.
    Schubiger O, Valavanis A, Hayek J (1980) Computed tomography in cerebral aneurysms with special emphasis on giant intracranial aneurysms. J Comput Assist Tomogr 4:24–32CrossRefPubMedGoogle Scholar
  30. 30.
    Schubiger O, Valavanis A, Wichmann W (1987) Growth-mechanism of giant intracranial aneurysms; demonstration by CT and MR imaging. Neuroradiology 29:266–271CrossRefPubMedGoogle Scholar
  31. 31.
    Stehbens WE (1982) Intracranial berry aneurysms in infancy. Surg Neurol 18:58–60CrossRefPubMedGoogle Scholar
  32. 32.
    Storrs BB, Humphreys RP, Hendrick EB, Hoffman HJ (1982) Intracranial aneurysms in the pediatric age-group. Childs Brain 9:358–361PubMedGoogle Scholar
  33. 33.
    Teng MM, Qadri SMN, Luo CB, Lirng JF, Chen SS, Chang CY (2003) MR imaging of giant intracranial aneurysm. J Clin Neurosci 10:460–464CrossRefPubMedGoogle Scholar
  34. 34.
    Ventureyra EC, Higgins MJ (1994) Traumatic intracranial aneurysms in childhood and adolescence. Case reports and review of the literature. Childs Nerv Syst 10:361–379CrossRefPubMedGoogle Scholar
  35. 35.
    Wessels T, Mosso M, Krings T, Klotzsch C, Harrer JU (2008) Extracranial and intracranial vertebral artery dissection: long-term clinical and duplex sonographic follow-up. J Clin Ultrasound 36:472–479CrossRefPubMedGoogle Scholar
  36. 36.
    Yasui T, Sakamoto H, Kishi H, Komiyama M, Iwai Y, Yamanaka K, Nishikawa M, Nakajima H, Kobayashi Y, Inoue T (1998) Rupture mechanism of a thrombosed slow-growing giant aneurysm of the vertebral artery—case report. Neurol Med Chir (Tokyo) 38:860–864CrossRefGoogle Scholar
  37. 37.
    Yazbak PA, McComb JG, Raffel C (1995) Pediatric traumatic intracranial aneurysms. Pediatr Neurosurg 22:15–19CrossRefPubMedGoogle Scholar
  38. 38.
    Zhao WY, Krings T, Alvarez H, Ozanne A, Holmin S, Lasjaunias P (2007) Management of spontaneous haemorrhagic intracranial vertebrobasilar dissection: review of 21 consecutive cases. Acta Neurochir (Wien) 149:585–596, discussion 596CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Timo Krings
    • 1
    • 2
    Email author
  • Sasikhan Geibprasert
    • 2
    • 3
    • 4
  • Karel G. terBrugge
    • 1
  1. 1.Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, UHNUniversity of TorontoTorontoCanada
  2. 2.The Service de Neuroradiologie Diagnostique et TherapeutiqueCHU Le-Kremlin-BicetreParisFrance
  3. 3.Department of Diagnostic Imaging, the Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
  4. 4.Department of Radiology, Ramathibodi HospitalMahidol UniversityBangkokThailand

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