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[Intracranial arterial aneurysm in children. A cooperative study. Apropos of 43 cases]
Insights
Pediatric intracranial arterial aneurysms are more common in males and often present as subarachnoid hemorrhage. Surgical removal of aneurysms offers encouraging outcomes for children, with most recovering fully.
Area of Science:
- Pediatric Neurosurgery
- Cerebrovascular Diseases
- Vascular Malformations
Background:
- Intracranial arterial aneurysms are rare in children but represent a significant cause of morbidity and mortality.
- Previous studies highlight a male predominance and specific locations within the circle of Willis.
Purpose of the Study:
- To describe the clinical characteristics, treatment, and outcomes of intracranial arterial aneurysms in a pediatric cohort.
- To analyze the epidemiological and topographical features of these aneurysms in children.
Main Methods:
- Retrospective case series of 43 pediatric patients diagnosed with intracranial arterial aneurysms.
- Review of clinical symptoms, diagnostic findings, surgical interventions, and postoperative outcomes.
Main Results:
- Aneurysms occurred predominantly in males (70%) with predilection for the carotid artery (39.3%) and anterior communicating artery (30%).
- Subarachnoid hemorrhage was the most common presentation (81%); 11% had a history of head injury.
- Surgical treatment resulted in cure without sequelae in 63.4%, mild disability in 19.5%, severe handicap in 4.8%, with a 12.3% mortality rate.
Conclusions:
- Intracranial arterial aneurysms in children, though uncommon, exhibit distinct epidemiological and topographical patterns.
- Surgical intervention is the standard treatment, yielding favorable outcomes due to pediatric cerebral plasticity and spasm tolerance.
Abstract:
This joint study describes 43 cases of intracranial arterial aneurysms in children diagnosed on the basis of clinical symptoms. In the pediatric age group, this malformation is notable because of the marked sex predilection in males (70%) and an unequal topographic incidence in the circle of Willis, where carotid artery (39.3%) and anterior communicating artery lesions (30%) predominate. The most frequent clinical sign was subarachnoid hemorrhage (81%), although symptoms caused by compression revealed the abnormality in 2.3% of patients. In this series, 11% of the patients suffered a head injury at the time of the hemorrhagic accident; this finding has been reported previously in the literature. Today, treatment is always surgical, consisting in removal of the aneurysmal sac. Surgical results are encouraging; all grade lesions considered together, 63.4% of the children were cured without any sequelae, 19.5% lost one school year but were able to lead a normal life, and 4.8% remained severely handicapped; overall postoperative mortality was 12.3%. Cerebral plasticity and tolerance of spasm in children are fundamental features of this aneurysmal pathology which partially explain the favorable results obtained with surgery.