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Pathomechanisms and treatment of pediatric aneurysms

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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.

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Authors and Affiliations

  1. Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, UHN, University of Toronto, 399 Bathurst St., 3MCL—429, Toronto, ON, M5T 2S8, Canada

    Timo Krings & Karel G. terBrugge

  2. The Service de Neuroradiologie Diagnostique et Therapeutique, CHU Le-Kremlin-Bicetre, Paris, France

    Timo Krings & Sasikhan Geibprasert

  3. Department of Diagnostic Imaging, the Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Sasikhan Geibprasert

  4. Department of Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Sasikhan Geibprasert

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  1. Timo Krings
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  2. Sasikhan Geibprasert
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  3. Karel G. terBrugge
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Correspondence to Timo Krings.

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Krings, T., Geibprasert, S. & terBrugge, K.G. Pathomechanisms and treatment of pediatric aneurysms. Childs Nerv Syst 26, 1309–1318 (2010). https://doi.org/10.1007/s00381-009-1054-9

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  • DOI: https://doi.org/10.1007/s00381-009-1054-9

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