Giant posterior cerebral artery aneurysm in a 4-year-old child: Case report

doi:10.1016/0090-3019(95)00362-2

Surgical Neurology

Volume 45, Issue 1, January 1996, Pages 31-35

https://doi.org/10.1016/0090-3019(95)00362-2 Get rights and content

Abstract

Posterior cerebral artery aneurysms in children aged 5 years or less are very rare. We were able to find only 10 cases previously described in the literature. We present a case of giant bilobulated aneurysm of the distal right posterior cerebral artery in a 4-year-old child with an initial history of spontaneous subarachnoid hemorrhage. The aneurysm was clipped and the patient had full recovery.

Based on the literature review, we discuss the characteristics of these rare aneurysms, making a comparison with different age groups.

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Pediatric Intracranial Aneurysms: Considerations and Recommendations for Follow-Up Imaging
2018, World Neurosurgery
Citation Excerpt :
Endovascular therapy is effective in the treatment of pediatric IAs13,18,60,112-116 but carries an inherently higher rate of recurrence of 15%–20%.81,117 Some authors have argued it is preferable to microsurgical clipping,24,118-121 although clipping, advanced microsurgical techniques, and combined modalities might be required for highly complex lesions.7,31,42,120,122-127 In a study from the University of California, San Francisco, obliteration rate of pediatric IAs was higher for microsurgical (94%) than for endovascular (82%) treatment.7,128
Pediatric intracranial aneurysms (IAs) are rare. Compared with adult IAs, they are more commonly giant, fusiform, or dissecting. Treatment often proves more complex, and recurrence rate and de novo aneurysmogenesis incidence are higher. A consensus regarding the most appropriate algorithm for following pediatric IAs is lacking.
We sought to generate recommendations based on the reported experience in the literature with pediatric IAs through a thorough review of the PubMed database, discussion with experienced neurointerventionalists, and our own experience.
Digital subtraction angiography (DSA) was utilized immediately post-operatively for microsurgically-clipped and endovascularly-treated IAs, at 6-12 months postoperatively for endovascularly-treated IAs, and in cases of aneurysmal recurrence or de novo aneurysmogenesis discovered by non-invasive imaging modalities. Computed tomographic angiography was the preferred imaging modality for long-term follow-up of microsurgically clipped IAs. Magnetic resonance angiography (MRA) was the preferred modality for following IAs that were untreated, endovascularly-treated, or microsurgically-treated in a manner other than clipping.
We propose incidental untreated IAs to be followed by magnetic resonance angiography without contrast enhancement. Follow-up modality and interval for treated pediatric IAs is determined by initial aneurysmal complexity, treatment modality, and degree of posttreatment obliteration. Recurrence or de novo aneurysmogenesis requiring treatment should be followed by digital subtraction angiography and appropriate retreatment. Computed tomography angiography is preferred for clipped IAs, whereas contrast-enhanced magnetic resonance angiography is preferred for lesions treated endovascularly with coil embolization and lesions treated microsurgically in a manner other than clipping.
Giant intracranial aneurysms in the paediatric population: Suggested management and a review of the literature
2016, Neurochirurgie
Citation Excerpt :
Between 1990 and 2012, 46 observations of a child with a giant intracranial aneurysm have been reported (Table 1). Most of them were published as a case report [12–46] and only some cases were included in case series [5,8,47] of a paediatric intracranial aneurysm. This cohort was characterized by a mean age of 7.5 years ± 4.8 (median, 8 years; age range 3 weeks to 16 years), and a slight male predominance (25 M/21 F, sex ratio M/F: 1.19).
Intracranial aneurysms are rare in children although giant aneurysms more commonly occur in adolescence. The aims of our study were to perform an extensive review of the literature over the past two decades and assess intracranial aneurysm management.
Based on a Pubmed search, we carried out a review of the literature from 1990 to 2012 regarding giant intracranial aneurysms diagnosed in the paediatric population. This descriptive study concerned clinical presentation, cerebral aneurysm characteristics, therapeutic management procedures and outcome.
Forty-six cases were reported in 31 papers. The male/female sex ratio was 1.15, the clinical presentation was a tumour mass syndrome in 56.6%, followed by rupture in 30.4%. The aneurysm location was the posterior circulation in 41.3%, and microsurgical treatment (52.2%) predominated over endovascular coiling (28.3%).
To date, no evidence-based medicine recommendation has been accepted for the management of rare intracranial aneurysms. Each reported patient was the object of a multidisciplinary clinical decision. Management of this challenging pathology should be performed on a case-to-case basis.
Les anévrismes géants de l’enfant, exceptionnels, sont rapportés uniquement sous forme d’observations. L’objectif de ce travail était de réaliser une revue exhaustive des publications sur le sujet afin de mieux définir cette situation clinique qui constitue un challenge thérapeutique.
À partir d’une recherche sur Pubmed, une analyse de la littérature entre 1990 et 2010 était réalisée à propos des anévrismes intracrâniens géants de l’enfant pour en dégager les caractéristiques. Les données rapportées intéressent les circonstances diagnostiques, la topographie, le traitement et l’évolution.
Notre revue rétrospective retrouve 46 cas cités dans 31 publications. Le sexe ratio est de 1,15. Le mode de révélation le plus fréquent est le syndrome tumoral à 56,6 % puis la rupture à 30,4 %. La fréquence de la localisation de ces anévrismes sur la circulation postérieure rejoint celle de la vascularisation antérieure (respectivement 41,3 % et 68,7 %). Le traitement reste principalement microchirurgical (52,2 %) mais l’alternative endovasculaire augmente progressivement (28,3 %).
Aucune recommandation de type evidence based medicine ne peut être proposée à partir de cette revue large de la littérature, mais la procédure endovasculaire devient actuellement un point incontournable de la discussion thérapeutique.
Specific characteristics and management strategies of posterior cerebral artery aneurysms: Report of eleven cases
2001, Journal of Clinical Neuroscience
Owing to the deep location of the posterior cerebral artery (PCA) and its close relationship with the brainstem and surrounding vital structures, surgical treatment of aneurysms in this region is complex. This study was undertaken in an attempt to bette r delineate the surgical risks of PCA aneurysms. A retrospective analysis was undertaken in 11 patients with PCA aneurysm surgically treated between 1988 and 1996 at Shinshu University and its affiliated hospitals. Data regarding surgical strategy, surgi cal complications and outcomes were analysed. Seven aneurysms were saccular (including one mycotic) and the other four were fusiform, dissecting, thrombosed and an infundibular dilatation. The locations of the aneurysms were at the P1 segment in two patients, P1-P2 junction in two, P2 segment in six and P3 segment in one.Six saccular non-mycotic aneurysms were treated with neck clipping and the other five aneurysms were treated each with proximal occlusion of the parent artery, excision of the aneurysm or wrapping. All aneurysms were satisfactorily exposed except one large saccular aneurysm. Surgical outcomes were either good recovery or moderate disability in 10 patients, and seve re disability in one patient with a large aneurysm due to temporal lobe contusion. In conclusion it is the responsibility of the surgeon dealing with rare PCA aneurysms to be aware of these specific characteristics and to appreciate which surgical techni que is appropriate for each patient.
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Intracranial aneurysms in childhood: Report of 8 cases and review of the literature
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Giant posterior cerebral artery aneurysm in a 4-year-old child: Case report

Abstract

Ann-Fr-Anesth Reanim

Surg Neurol

Intracranial arterial aneurysm in infancy and childhood

Childs Brain

Cerebral artery aneurysm in infancy and adolescence

Childs Brain

Giant aneurysm arising from a single arteriovenous fistula in a child: case report

J Neurosurg

Multiple cerebral artery aneurysms in an infant: case report

J Neurosurg

Surgical treatment of arterial aneurysms of the vertebrobasilar circulation

J Neurosurg

Intracranial aneurysm in early childhood

Surg Neurol

Giant serpentine aneurysm of the posterior cerebral artery

Neurosurgery

Subarachnoid hemorrhage in childhood secondary to ruptured aneurysm in infants: report of two cases

J Neurosurg

Subarachnoid hemorrhage in childhood and adolescence

J Neurosurg

A systemic analysis of intracranial aneurysms from the autopsy file of the Presbyterian Hospital, 1914 to 1956

J Neuropathol Exp Neurol

Multiple huge intracranial aneurysms in infants and young children: report of a case with review of the literature

Brain Nerve (Tokyo)

Ruptured intracranial aneurysm in the first year of life

Arch Neurol

Infantile cerebral aneurysm

Surg Neurol

Arteriella aneurysm med subarachnoidal-boldining has barm

Nord Med

Les aneurysmes intracraniens chez I enfant: a propos de 4 observations

Société de Neurochirurgie de Langue Française

Aneurysm in the third ventricle

Neurology (Minneap)

Congenital sacular aneurysm in a 19-day-old neonate: the case report and review of the literature

Surg Neurol