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Pediatric intracranial distal arterial aneurysms: report of 35 cases
Ruiqi Chen, Si Zhang, Rui Guo1
1Department of Neurosurgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
Insights
Pediatric intracranial distal arterial aneurysms (PIDAAs) are common and often present with severe headaches or seizures. Surgical treatment of PIDAAs may offer better seizure control compared to endovascular methods.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Vascular Neurology
Background:
- Research on pediatric intracranial aneurysms is extensive, yet studies on pediatric intracranial distal arterial aneurysms (PIDAAs) are limited.
- PIDAAs represent a significant subset of pediatric intracranial aneurysms.
Purpose of the Study:
- To investigate the characteristics, treatment, and outcomes of pediatric intracranial distal arterial aneurysms (PIDAAs).
- To compare the efficacy of surgical versus endovascular treatment for PIDAAs, particularly regarding seizure control.
Main Methods:
- Retrospective review of pediatric patients (≤18 years) with PIDAAs treated between January 2012 and April 2017.
- Analysis of aneurysm location, patient demographics, clinical presentation, treatment modality, and follow-up outcomes.
Main Results:
- Thirty-five PIDAAs were identified in 35 pediatric patients, with a mean age of 9.2 years and a male predominance (71.4%).
- Common symptoms included severe headache (62.9%) and seizures (60%). Ruptured aneurysms occurred in 77.1%, often with intracerebral hematoma.
- Middle cerebral artery (MCA) was the most frequent site (65.7%). Pseudoaneurysms were noted in 22.9%, frequently associated with head trauma.
- Favorable outcomes were achieved in 85.7% at 6 months. Surgical intervention showed a significantly greater reduction in seizure rates compared to endovascular treatment (P=0.036).
Conclusions:
- PIDAAs are a notable proportion of pediatric intracranial aneurysms, characterized by a propensity for the MCA and association with seizures and pseudoaneurysms.
- Head trauma is a significant risk factor for pseudoaneurysms in this population.
- Surgical management appears more beneficial than endovascular approaches for mitigating seizure risk in pediatric patients with PIDAAs.
Background:
Although research on pediatric intracranial aneurysms is well documented, studies of pediatric intracranial distal arterial aneurysms (PIDAAs) remain scarce.
Methods:
All pediatric patients (≤ 18 years) with intracranial aneurysms located distally to the M2 segment of the middle cerebral artery (MCA), A2 segment of the anterior cerebral artery, P2 segment of the posterior cerebral artery, and other cerebral arteries distal to the main branch who were treated at our center between January 2012 and April 2017 were retrospectively reviewed.
Results:
Thirty-five PIDAAs were observed in 35 patients with a mean age of 9.2 ± 5.9 years and a male ratio of 71.4% (n = 25). Sudden onset of severe headache was the most common symptom (n = 22, 62.9%), followed by seizures (n = 21, 60%). Twenty-seven patients (77.1%) had ruptured aneurysms, and 18 of them (66.7%) exhibited combined lobe intracerebral hematoma. MCA was the most common site (n = 23, 65.7%). Large or giant aneurysms were observed in 16 patients (45.7%). Eight patients (22.9%) had pseudoaneurysms, six of whom (75%) reported a head trauma history. Thirty patients (85.7%) had favorable outcomes at the end of the 6-month follow-up. Kaplan-Meier 6-month seizure curves revealed a significantly higher decrease in seizure rates in the surgical group than in the endovascular group (P = 0.036).
Conclusions:
PIDAAs constitute a high proportion of pediatric intracranial aneurysms. PIDAAs are associated with an increased risk of seizures, a predilection for the MCA, and a high incidence of pseudoaneurysms with head trauma history. Surgical intervention is of greater benefit than endovascular treatment in controlling the risk of seizures.
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