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AJNR - American Journal of Neuroradiology

Published ahead of print on April 8, 2009
doi: 10.3174/ajnr.A1587

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American Journal of Neuroradiology 30:1315-1324, August 2009
© 2009 American Society of Neuroradiology

PEDIATRICS

Intracranial Aneurysms in Childhood: 27-Year Single-Institution Experience

S.W. Hetts^a, J. Narvid^d, N. Sanai^b, M.T. Lawton^b, N. Gupta^b, H.J. Fullerton^c, C.F. Dowd^a, R.T. Higashida^a and V.V. Halbach^a

^a Department of Radiology, University of California, San Francisco, San Francisco, Calif
^b Department of Neurological Surgery, University of California, San Francisco, San Francisco, Calif
^c Department of Neurology, University of California, San Francisco, San Francisco, Calif
^d Department of Radiology, Stanford University, Palo Alto, Calif

Please address correspondence to Steven W. Hetts, MD, 505 Parnassus Ave, L-352, San Francisco, CA 94143-0628; e-mail: steven.hetts{at}radiology.ucsf.edu

BACKGROUND AND PURPOSE: Pediatric aneurysms are rare and, thus, relatively poorly understood as compared to those in adults. Our aim was to characterize the clinical, imaging, treatment, and outcome data of patients younger than 19 years diagnosed with intracranial aneurysms at a tertiary care institution.

MATERIALS AND METHODS: We performed a retrospective medical record review of pediatric patients examined at our university hospital between 1981 and 2008.

RESULTS: We evaluated 77 patients (mean age, 12 years; 40 female, 37 male) with 103 intracranial aneurysms. Patients presented with headache (45%), cranial neuropathies (16%), nausea/vomiting (15%), vision changes (13%), trauma (13%), seizure (4%), or sensory changes (3%). Subarachnoid hemorrhage occurred in 25 patients. Thirty-one fusiform aneurysms occurred in 25 patients. Forty-seven saccular aneurysms occurred in 35 patients. Twelve infectious aneurysms occurred in 6 patients. Fifteen traumatic aneurysms occurred in 12 patients. Fifty-nine patients underwent treatment of their aneurysms; 18 patients’ conditions were managed conservatively. Nineteen patients underwent primary endovascular coiling, 1 patient had endovascular stent-assisted coiling, 11 patients underwent endovascular parent artery occlusion, 19 patients underwent surgical clipping, and 10 patients had aneurysms trapped and bypassed. Mortality was 1.3%. Morbidity included 8% infarction and 4% new-onset seizures. Six patients developed new aneurysms or had enlargement of untreated aneurysms.

CONCLUSIONS: In our experience, intracranial aneurysms of childhood show a female predilection and predominantly saccular morphology. In neurovascular centers where microneurosurgical and endovascular options are available, most children with intracranial aneurysms can be successfully treated with low morbidity and mortality. Fusiform aneurysms require a combined microneurosurgical and endovascular approach more often than saccular aneurysms. The development of new aneurysms in pediatric patients during limited follow-up warrants further investigation.