Pediatric Intracranial Aneurysms
Section snippets
Clinical presentation
As in adults, children with intracranial aneurysms can present with subarachnoid hemorrhage (SAH), headache, direct compressive effects, focal neurologic deficits, or seizures. If SAH is present, nearly 60% of patients will have a cerebral aneurysm.22 Fusiform aneurysms tend to present with nonhemorrhagic deficits.19 Many patients (30%–85%) with SAH confirmed by radiographic imaging or lumbar puncture typically present good clinical function defined by a Hunt and Hess grade between 1 and 3.
Diagnosis
With the increasing availability of multidetector computed tomographic (CT) scanners, magnetic resonance imaging (MRI), and 3-dimensional image processing, the identification of a cerebral aneurysm as a cause of SAH can occur not only in a tertiary referral center but also at a community hospital. Furthermore, the technical quality of catheter angiography has improved over the last decade with advances such as 3-dimensional rotational angiography and angio-CT. These technological improvements
Aneurysm features
The overall location and size of aneurysms in children differ from those found in the adult population.12, 19, 32, 33 Aneurysms of the internal carotid artery (ICA) typically occur at similar frequencies in both populations. However, there is a greater preponderance of aneurysms at the ICA terminus in the pediatric patient compared with the adult (Table 2). Aneurysms of the middle cerebral artery (MCA) appear to occur in similar distributions between the 2 subgroups. Approximately 18% of
General Principles
It is clear that a multidisciplinary team consisting of stroke neurologists, cerebrovascular neurosurgeons, and neurointerventional radiologists is best able to treat complex intracranial aneurysms and achieve optimal results.35 Treatment options include observation, endovascular therapy, or surgical clipping. Endovascular treatment includes the use of detachable coils with or without stents delivered through microcatheters after transfemoral selective catheterization of the involved
Proposed follow-up guidelines
Regardless of aneurysm treatment or observation, children with intracranial aneurysms require follow-up imaging and clinical surveillance, given their expected long life spans during which additional aneurysms could arise or treated aneurysms could recur. As suggested previously,12 aneurysmal disease is both an acute and chronic condition and requires longitudinal management, with emphasis on the ongoing disease entity itself as opposed to just the mode of treatment when an aneurysm becomes
Summary
Intracranial aneurysms in children differ from those in adults in location, morphology, etiology, natural history, and, hence, management. Several series have been published detailing the experience of various institutions with pediatric intracranial aneurysms,12, 18, 37 including the authors' institution.19, 20 Childhood aneurysms have a higher rate of posterior circulation, ICA terminus, fusiform, and giant aneurysms as compared with adult patients with aneurysms. Furthermore, improved
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