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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Pediatric intracranial aneurysms in a Southern Brazilian population
Zeferino Demartini1,2,3, Junio Pereira Pardins4, Gelson Luis Koppe5,4
1Department of Neurosurgery, Complexo Hospital de Clinicas, UFPR, Rua General Carneiro 181, 8° andar, Curitiba, 80.060-900, PR, Brazil. demartiniz@gmail.com.
Insights
Pediatric intracranial aneurysms are rare, often presenting with hemorrhage. Treated patients, predominantly male with internal carotid artery involvement, achieved favorable outcomes regardless of treatment method.
Area of Science:
- Pediatric neurosurgery
- Cerebrovascular diseases
- Medical imaging
Background:
- Intracranial aneurysms are uncommon in children, posing diagnostic challenges.
- Pediatric aneurysms exhibit distinct characteristics compared to adult cases, with hemorrhage being the primary presentation.
Purpose of the Study:
- To analyze clinical data, aneurysm features, and treatment outcomes in pediatric patients (<19 years) with intracranial aneurysms.
Main Methods:
- Retrospective cross-sectional observational study.
- Analysis of medical records and imaging studies.
- Inclusion of variables: age, sex, presentation, comorbidities, aneurysm characteristics, treatment, and outcomes.
Main Results:
- 15 aneurysms identified in 11 pediatric patients (mean age 5.2 years); 45% presented with hemorrhage.
- Internal carotid artery was the most common site (47%); 27% were giant aneurysms.
- 91% of treated patients achieved good functional outcomes (mRS ≤ 2), irrespective of endovascular or surgical treatment.
Conclusions:
- Pediatric intracranial aneurysms in this cohort were more prevalent in males, frequently involved the internal carotid artery, and often presented hemorrhagically.
- Favorable functional outcomes were observed in all treated patients, highlighting the efficacy of available treatment modalities.
Introduction:
Intracranial aneurysms are rare in the pediatric population, and their diagnosis can be challenging. They differ from their adult counterparts in several aspects, and hemorrhage is the most common presentation.
Objective:
To evaluate clinical data, aneurysm characteristics, and therapeutic results in a series of patients younger than 19 years of age with intracranial aneurysms.
Method:
A retrospective cross-sectional observational study design analyzed medical records and imaging studies. Variables included age, sex, clinical presentation, comorbidities, aneurysmal characteristics, treatment modality, and clinical outcomes.
Results:
We identified 15 intracranial aneurysms in 11 patients (6 male), with ages ranging from 3 months to 15 years (mean age 5.2 years). Five patients had associated medical conditions, and hemorrhage was the most frequent clinical presentation (45%). Three patients (27%) had multiple aneurysms, and seven aneurysms were fusiform or dysplastic. The internal carotid artery was the most affected site, involved in 47% of cases. Aneurysm size ranged from 2 to 60 mm (mean 16.8 mm), with giant aneurysms in 27%. Seven patients were treated with endovascular procedures, while three aneurysms were clipped. Symptomatic vasospasm requiring angioplasty occurred in two patients and led to worse outcomes. One patient died due to severe aspiration pneumonia and sepsis that precluded treatment. Good functional outcome (modified Rankin scale - mRS ≤ 2) was achieved in all treated patients (91%).
Conclusion:
The patients with aneurysms in this series were mostly male, presented mostly hemorrhagic syndromes, and mainly had internal carotid artery involvement. The outcome of treated patients was favorable, regardless of treatment modality.
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