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Pediatric brain aneurysms: a review of 1458 brain MR angiograms

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Abstract

Purpose

To evaluate clinical and imaging characteristics of pediatric brain aneurysms.

Materials and Methods

A retrospective review of 1458 MR angiograms of pediatric patients (≤18 years old) obtained between 2006 and 2021 was performed. A non-infundibular arterial luminal outpouching larger than 1mm in size was identified as an “Intracranial aneurysm.” Patient demographics, clinical presentations, and predisposing risk factors, including family history and underlying medical conditions, were reviewed. MRA images were analyzed for aneurysm location, number, maximum diameter, and interval changes on follow-up.

Results

Forty-nine (3.3%) patients (30 females, 19 males) with 64 intracranial aneurysms were identified with an average age of 13.71 ± 3.67 years. Eleven (22.4%) patients had multiple aneurysms. An underlying systemic illness was observed in 81.6% (40/49) cases, with sickle cell disease as the most frequent (25/49, 51%) diagnosis. A first-degree family history of intracranial aneurysms was recognized in 36/1458 (2.5%) patients. However, no intracranial aneurysm was found in this group. While 02/49 (4%) patients presented with acute SAH, headache was the most common (16/49, 32.7%) symptom at presentation in unruptured cases. The majority (47/64, 73.4%) of the aneurysms were located in the anterior circulation, with the ICA ophthalmic segment being most frequently (24/47, 51%) involved. Most (54/64, 84.4%) aneurysms were smaller than 4mm in size at the time of diagnosis. At least one follow-up MRA was obtained in 72.3% (34/47) of the unruptured aneurysms cohort. There was no change in the aneurysm size and morphology in 31/34 (91.2 %) patients over an average imaging follow-up of 39.6 months. Three (6%) patients demonstrated an interval increase in the aneurysm size. SAH patients (n=2) and two unruptured aneurysm patients with an interval increase in size were successfully treated with endovascular techniques.

Conclusion

Female predominance with a higher frequency of small and unruptured intracranial aneurysms was recognized in our cohort. A higher incidence of an underlying systemic illness, especially sickle cell disease, was also noted. Most intracranial aneurysms in children appear to remain stable. However, there seems to be the risk of an aneurysm size increase which warrants regular clinical and imaging follow-up.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, [SKL]. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

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Authors and Affiliations

  1. Department of Radiology, Montefiore Medical Center and Children’s Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA

    Deepak Khatri, Richard Zampolin, Steven Benitez, Aureliana Toma, Allan Brook & Seon-Kyu Lee

  2. Department of Neurology, Montefiore Medical Center and Children’s Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA

    Daniel Lax & Seon-Kyu Lee

  3. Department of Neurosurgery, Montefiore Medical Center and Children’s Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA

    Deepak Khatri, Mandana Behbahani, Andrew Kobets, Ryan Holland, Allan Brook & Seon-Kyu Lee

  4. Department of Pediatrics, Montefiore Medical Center and Children’s Hospital at Montefiore (CHAM), Bronx, New York, 10467, USA

    Deepa Manwani

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  1. Deepak Khatri
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  10. Allan Brook
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Contributions

Conception of the work: SKL and DK; Data Collection: DK, RZ, SB, AT, and RH; Data analysis and interpretation: SKL, DK, RZ, and SB; Drafting the article: DK and SKL; Critical revision: RZ, MB, AK, DL, DM, SB, AT, RH, and AB; Final approval of the version to be published: SKL

Corresponding author

Correspondence to Seon-Kyu Lee.

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Khatri, D., Zampolin, R., Behbahani, M. et al. Pediatric brain aneurysms: a review of 1458 brain MR angiograms. Childs Nerv Syst 39, 3249–3254 (2023). https://doi.org/10.1007/s00381-023-05967-4

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