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Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment

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Published on: September 25, 2009

Dissecting giant vertebro-basilar aneurysms.

Luca Massimi¹, Jacques Moret, Giampiero Tamburrini

¹Pediatric Neurosurgery, Catholic University School of Medicine, Largo A. Gemelli, 8, 00168 Rome, Italy. lucamax30@hotmail.com

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery

|April 26, 2003

Summary

Giant vertebro-basilar dissecting aneurysms (VDAs) are rare in children. Endovascular embolization is a viable treatment option, but carries risks, as demonstrated by this case report.

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Area of Science:

Pediatric Neurology
Vascular Neurosurgery
Interventional Neuroradiology

Background:

Vertebro-basilar dissecting aneurysms (VDAs) are exceptionally rare in pediatric populations.
Clinical presentations can be non-specific, complicating early diagnosis.
Intracranial mass effect is an unusual manifestation of pediatric VDAs.

Observation:

An 8-year-old girl presented with progressive neurological deficits including hemiparesis, ataxia, dysphagia, and dysphonia.
Neuroimaging revealed a giant dissecting aneurysm originating from the left vertebral artery, extending to the vertebro-basilar junction.
The patient exhibited symptoms indicative of significant intracranial mass effect.

Findings:

Endovascular treatment using coil embolization was performed for the giant VDA.
Initial post-operative recovery showed marked clinical improvement.
The patient subsequently developed a fatal cerebral hemorrhage.

Implications:

Pediatric VDAs can present atypically, posing diagnostic and therapeutic challenges.
Endovascular embolization is a potential treatment modality for pediatric VDAs.
Despite treatment, significant risks, including mortality, persist with interventions for VDAs.