Microsurgical management of pediatric intracranial aneurysms

Pediatric aneuryms are rare and have characteristics that distinguish them from their adult counterparts. There is a greater capacity for pediatric aneurysms to arise de novo and progress rapidly.

Saccular aneurysms are rarer; fusiform/giant aneurysms are more common. Hemorrhage is less common at presentation than are symptoms that result from mass effect. These patients also present with comorbidities that are unique to children and these conditions may influence treatment selection between minimally invasive procedures and microsurgery. Life expectancy is typically measured in decades for this population and thus treatment durability is of considerable importance.

Our retrospective review indicated that complete aneurysm obliteration occurred in 93% of microsurgery patients versus 79% of endovascular patients. Although functional outcomes were similar for both treatment modalities, the need for additional treatment was over four times more likely in children receiving endovascular therapy.

The need for continued follow-up cannot be overstated for this patient group, therefore, nor can the collaborative efforts of both surgeons and interventionalists to design the most appropriate treatment approach.