Pediatric intracranial aneurysms: simple and complex cases

Between 1984 and 1990, 20 aneurysms in 16 patients (9 males and 7 females), 18 years or younger (mean age, 8 years; range, 7 months to 18 years), were treated at our institution. Seven patients had a solitary saccular aneurysm located at an arterial bifurcation which manifested as a subarachnoid hemorrhage. Six of these patients were treated with clip obliteration. Postoperative results were excellent or good in 5 and fair in 1. Nine patients had complex or multiple aneurysms of variable origins (3 giant, 2 infectious, 2 traumatic and 2 associated with an arteriovenous malformation) and presentation. Surgical treatment of these children required the use of hypothermic arrest, trapping, bypass and anastomotic procedures. Outcome was excellent or good in 7 and fair in 2. An analysis of these patients with regard to pathogenesis and management is presented.