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Published on: August 11, 2015
Intracranial aneurysms in childhood: 27-year single-institution experience
1Department of Radiology, University of California, San Francisco, Calif, USA. steven.hetts@radiology.ucsf.edu
Insights
Pediatric intracranial aneurysms are rare, often presenting with headaches and varying morphologies. Treatment in specialized centers offers low morbidity and mortality, though new aneurysms may develop.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Vascular Neurology
Background:
- Intracranial aneurysms in children are uncommon and less understood than adult counterparts.
- Characterizing pediatric intracranial aneurysms is crucial for improving diagnosis and treatment.
- Limited data exists on the clinical presentation, imaging, treatment, and outcomes of pediatric intracranial aneurysms.
Purpose of the Study:
- To characterize the clinical, imaging, treatment, and outcome data of pediatric patients (<19 years) with intracranial aneurysms.
- To identify trends in aneurysm morphology, presentation, and management in a pediatric population.
- To evaluate the success rates and complications associated with various treatment modalities for pediatric intracranial aneurysms.
Main Methods:
- Retrospective review of medical records from 1981 to 2008.
- Inclusion criteria: patients younger than 19 years diagnosed with intracranial aneurysms.
- Data collected included clinical presentation, aneurysm type, treatment received, and patient outcomes.
Main Results:
- 77 pediatric patients with 103 intracranial aneurysms were analyzed (mean age 12 years).
- Common presentations included headache (45%), cranial neuropathies (16%), and nausea/vomiting (15%). Subarachnoid hemorrhage occurred in 25 patients.
- Saccular aneurysms were most common (47), followed by fusiform (31), traumatic (15), and infectious (12). Treatment included endovascular coiling/occlusion (30), surgical clipping (19), and bypass (10); 18 were managed conservatively. Mortality was 1.3%, with 8% infarction and 4% new seizures.
Conclusions:
- Pediatric intracranial aneurysms show a female predilection and predominantly saccular morphology.
- Successful treatment with low morbidity and mortality is achievable in specialized neurovascular centers.
- Fusiform aneurysms often necessitate combined endovascular and surgical approaches. Further research is needed on the development of new aneurysms in pediatric patients.
Background And Purpose:
Pediatric aneurysms are rare and, thus, relatively poorly understood as compared to those in adults. Our aim was to characterize the clinical, imaging, treatment, and outcome data of patients younger than 19 years diagnosed with intracranial aneurysms at a tertiary care institution.
Materials And Methods:
We performed a retrospective medical record review of pediatric patients examined at our university hospital between 1981 and 2008.
Results:
We evaluated 77 patients (mean age, 12 years; 40 female, 37 male) with 103 intracranial aneurysms. Patients presented with headache (45%), cranial neuropathies (16%), nausea/vomiting (15%), vision changes (13%), trauma (13%), seizure (4%), or sensory changes (3%). Subarachnoid hemorrhage occurred in 25 patients. Thirty-one fusiform aneurysms occurred in 25 patients. Forty-seven saccular aneurysms occurred in 35 patients. Twelve infectious aneurysms occurred in 6 patients. Fifteen traumatic aneurysms occurred in 12 patients. Fifty-nine patients underwent treatment of their aneurysms; 18 patients' conditions were managed conservatively. Nineteen patients underwent primary endovascular coiling, 1 patient had endovascular stent-assisted coiling, 11 patients underwent endovascular parent artery occlusion, 19 patients underwent surgical clipping, and 10 patients had aneurysms trapped and bypassed. Mortality was 1.3%. Morbidity included 8% infarction and 4% new-onset seizures. Six patients developed new aneurysms or had enlargement of untreated aneurysms.
Conclusions:
In our experience, intracranial aneurysms of childhood show a female predilection and predominantly saccular morphology. In neurovascular centers where microneurosurgical and endovascular options are available, most children with intracranial aneurysms can be successfully treated with low morbidity and mortality. Fusiform aneurysms require a combined microneurosurgical and endovascular approach more often than saccular aneurysms. The development of new aneurysms in pediatric patients during limited follow-up warrants further investigation.
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