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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Endovascular treatment for pediatric intracranial aneurysms
Xianli Lv1, Chuhan Jiang, Youxiang Li
1Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan Xili, Beijing 100050 Hebei, People's Republic of China.
Insights
Pediatric intracranial aneurysms are more common in males, often affecting the vertebral artery (VA), posterior cerebral artery (PCA), and middle cerebral artery (MCA). Parent vessel occlusion (PVO) is a safe and effective treatment, though basilar trunk aneurysms pose high mortality risks.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Vascular Neurology
Background:
- Intracranial aneurysms in pediatric patients are rare but can lead to significant morbidity.
- Understanding the demographic, clinical, and anatomical characteristics is crucial for effective management.
Purpose of the Study:
- To characterize pediatric intracranial aneurysms.
- To report treatment outcomes in this patient population.
Main Methods:
- Retrospective review of 25 pediatric patients (aged ≤17 years) treated between 1998 and 2005.
- Analysis of aneurysm location, presenting symptoms (subarachnoid hemorrhage, incidental finding, cranial nerve dysfunction, neurological deficits), and treatment modalities (selective embolization, parent vessel occlusion (PVO), stent-assisted coiling).
Main Results:
- Common locations included vertebral artery (VA; n=9), middle cerebral artery (MCA; n=5), and posterior cerebral artery (PCA; n=4).
- Parent vessel occlusion (PVO) was used in 16 patients, while 5 underwent selective embolization with coils.
- High Glasgow Outcome Scale scores (4 or 5) were achieved in 96% of patients at a mean follow-up of 23.5 months.
Conclusions:
- Pediatric intracranial aneurysms show a male predilection and favor specific locations (VA, PCA, MCA).
- Parent vessel occlusion (PVO) demonstrates efficacy and safety for fusiform aneurysms.
- Basilar trunk fusiform aneurysms present significant treatment challenges and are associated with high mortality.
Introduction:
The purpose of this study is to report the characteristics and outcomes of pediatric patients with intracranial aneurysms.
Methods:
From 1998 to 2005, 25 pediatric patients (aged < or =17 years) with intracranial aneurysm were treated at our institute. Eleven of 25 patients had subarachnoid hemorrhage. In ten patients, the aneurysm was an incidental finding. One patient presented with cranial nerves dysfunction and three with neurological deficits. The locations of the aneurysms were as follows: vertebral artery (VA; n = 9), middle cerebral artery (MCA; n = 5), posterior cerebral artery (PCA; n = 4), basilar artery (BA; n = 2), anterior communicating artery (n = 2), anterior cerebral artery (n = 2), and internal carotid artery (n = 1).
Results:
Five patients were treated with selective embolization with coils. Sixteen patients were treated with parent vessel occlusion (PVO). Eight PVOs were performed with balloons and eight were performed with coils. One patient with a VA aneurysm was spontaneously thrombosed 4 days after the initial diagnostic angiogram. In three patients treated with stent alone or stent-assisted coiling, one with BA trunk aneurysm died. One aneurismal recurrence occurred and was retreated. At a mean follow-up duration of 23.5 months, 96% of patients had a Glasgow Outcome Scale score of 4 or 5.
Conclusions:
Pediatric intracranial aneurysms occur more commonly in male patients and have a predilection for the VA, PCA, and MCA. PVO is an effective and safe treatment for fusiform aneurysms. Basilar trunk fusiform aneurysms were difficult to treat and were associated with a high mortality rate.
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