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Pediatric Intracranial Aneurysms: Considerations and Recommendations for Follow-Up Imaging
Michael George Zaki Ghali1, Visish M Srinivasan2, Jacob Cherian2
1Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
Insights
Follow-up imaging for pediatric intracranial aneurysms (IAs) depends on treatment. Magnetic resonance angiography (MRA) is preferred for untreated or certain treated IAs, while CT angiography is used for clipped aneurysms.
Area of Science:
- Neuroscience
- Radiology
- Pediatric Neurology
Background:
- Pediatric intracranial aneurysms (IAs) are rare and often present as giant, fusiform, or dissecting types.
- Treatment of pediatric IAs is complex, with higher rates of recurrence and new aneurysm formation compared to adults.
- There is a lack of consensus on the optimal follow-up strategy for pediatric IAs.
Purpose of the Study:
- To establish evidence-based recommendations for the follow-up of pediatric intracranial aneurysms.
- To synthesize current literature and expert experience to guide clinical management.
- To address the need for a standardized follow-up algorithm for pediatric IAs.
Main Methods:
- A comprehensive literature review of the PubMed database was conducted.
- Discussions were held with experienced neurointerventionalists to gather expert opinions.
- The authors' own clinical experience with pediatric IAs was incorporated.
Main Results:
- Digital subtraction angiography (DSA) is used post-operatively and for suspected recurrence.
- CT angiography is preferred for long-term follow-up of surgically clipped IAs.
- MRA is the preferred modality for untreated, endovascularly-treated, or non-clipped microsurgically-treated IAs.
Conclusions:
- Untreated IAs should be monitored with non-contrast MRA.
- Follow-up for treated pediatric IAs depends on aneurysm complexity, treatment type, and obliteration.
- Recurrent or de novo aneurysms require DSA and retreatment, with specific imaging choices based on prior treatment.
Background:
Pediatric intracranial aneurysms (IAs) are rare. Compared with adult IAs, they are more commonly giant, fusiform, or dissecting. Treatment often proves more complex, and recurrence rate and de novo aneurysmogenesis incidence are higher. A consensus regarding the most appropriate algorithm for following pediatric IAs is lacking.
Methods:
We sought to generate recommendations based on the reported experience in the literature with pediatric IAs through a thorough review of the PubMed database, discussion with experienced neurointerventionalists, and our own experience.
Results:
Digital subtraction angiography (DSA) was utilized immediately post-operatively for microsurgically-clipped and endovascularly-treated IAs, at 6-12 months postoperatively for endovascularly-treated IAs, and in cases of aneurysmal recurrence or de novo aneurysmogenesis discovered by non-invasive imaging modalities. Computed tomographic angiography was the preferred imaging modality for long-term follow-up of microsurgically clipped IAs. Magnetic resonance angiography (MRA) was the preferred modality for following IAs that were untreated, endovascularly-treated, or microsurgically-treated in a manner other than clipping.
Conclusions:
We propose incidental untreated IAs to be followed by magnetic resonance angiography without contrast enhancement. Follow-up modality and interval for treated pediatric IAs is determined by initial aneurysmal complexity, treatment modality, and degree of posttreatment obliteration. Recurrence or de novo aneurysmogenesis requiring treatment should be followed by digital subtraction angiography and appropriate retreatment. Computed tomography angiography is preferred for clipped IAs, whereas contrast-enhanced magnetic resonance angiography is preferred for lesions treated endovascularly with coil embolization and lesions treated microsurgically in a manner other than clipping.
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Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...