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Giant pseudoaneurysm in adolescent.

Hyeong-Joong Yi¹, Kwang-Myung Kim, Yong Ko

¹Department of Neurosurgery, Hanyang University Medical Center, Sungdong-gu, 133-792 Seoul, South Korea. hjyi8499@hanyang.ac.kr

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

|September 1, 2005

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This case study highlights a rare giant intracranial pseudoaneurysm in a young male, presenting with chronic headache. Surgical intervention successfully resolved symptoms, emphasizing prompt treatment for favorable outcomes in such unusual vascular lesions.

Area of Science:

Vascular Surgery
Pediatric Neurology
Neuroradiology

Background:

Intracranial pseudoaneurysms are rare vascular lesions in children and adolescents, distinct from true aneurysms.
They typically arise from trauma or infection, with spontaneous development being exceptionally rare.
Giant pseudoaneurysms in young individuals are often symptomatic and carry a high risk of rupture.

Observation:

A 17-year-old boy presented with a 3-year history of medically intractable headaches.
Imaging revealed a giant pseudoaneurysm of the distal middle cerebral artery without evidence of acute hemorrhage.
Digital subtraction angiography showed characteristic delayed contrast filling and emptying.

Findings:

Surgical obliteration via tandem clipping and aneurysmectomy was performed.

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The patient experienced complete resolution of headaches postoperatively.

Histopathology supported a potential link to a remote blunt head injury with micro-bleeding.

Implications:

This case underscores the possibility of pseudoaneurysm formation without a clear inciting event, potentially linked to remote trauma.
Chronic headache can be an atypical presentation of intracranial pseudoaneurysms in adolescents.
Prompt surgical management is crucial for favorable outcomes in pediatric giant pseudoaneurysms.