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Ruptured dissecting cerebral aneurysms in young people: report of three cases

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Abstract

Intracranial arterial aneurysms in the pediatric population are rare. Among these, dissecting aneurysms are the most frequent, followed by saccular, infectious, and posttraumatic. It is widely known that aneurysmal rupture is uncommon in the first two decades of life. Spontaneous dissecting aneurysms (SDAs) of the middle cerebral artery (MCA) affecting young individuals most frequently present as occlusive syndrome with ischemia, although bleeding and subarachnoid hemorrhage can also occur. Between March 2006 and January 2008, three young patients (20 months, 8 and 20 years old) were surgically treated for MCA SDA in the Neurosurgical Department of “12 de Octubre” Hospital of Madrid. These patients showed hemorrhage as primary radiological finding, and all of them underwent surgical operation. Aneurysms were always treated by trapping, with aneurysmectomy in one case, but no distal extra-intracranial (EC-IC) bypass was performed. In two cases, the histological examination of the aneurysm’s wall evidenced signs of subintimal dissection with widespread disruption of the internal elastic lamina and media with neointima formation and intramural hemorrhage. Although bleeding is an uncommon presenting sign of SDAs, they should be suspected in young people showing hemorrhage at CT scan. Early surgical treatment and, if possible, preoperative neuroimaging evaluation of intracranial vessels should be performed to reduce the mortality in these patients despite a higher postoperative morbidity. From a technical point of view, surgical trapping of the aneurysm seems to be a reasonable treatment strategy especially in an emergency basis. However, whenever possible, an EC-IC bypass could help diminish the ischemic morbidity associated with these aneurysms.

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Acknowledgments

This investigation was supported by grant 2007/82 from the Fundacion Mutua Madrileña and Fondo de Investigaciones Sanitarias grant FIS PI 070152.

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Authors and Affiliations

  1. Department of Neurosurgery, Di Circolo University Hospital, University of Insubria, Varese, Italy

    Stefano Peron

  2. Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain

    Luis Jimenez-Roldán, Marta Cicuendez, Ramiro D. Lobato, Rafael Alday, José F. Alén & Alfonso Lagares

  3. Department of Neurorradiology, Hospital 12 de Octubre, Madrid, Spain

    Jose María Millán

  4. Department of Neuropathology, Hospital 12 de Octubre, Madrid, Spain

    Jose Ramón Ricoy

Authors
  1. Stefano Peron
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  2. Luis Jimenez-Roldán
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  3. Marta Cicuendez
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  4. Jose María Millán
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  5. Jose Ramón Ricoy
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  6. Ramiro D. Lobato
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  7. Rafael Alday
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  8. José F. Alén
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  9. Alfonso Lagares
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Correspondence to Alfonso Lagares.

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Peron, S., Jimenez-Roldán, L., Cicuendez, M. et al. Ruptured dissecting cerebral aneurysms in young people: report of three cases. Acta Neurochir 152, 1511–1517 (2010). https://doi.org/10.1007/s00701-010-0688-4

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  • DOI: https://doi.org/10.1007/s00701-010-0688-4

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