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Intracranial aneurysms and subarachnoid hemorrhage in children and adolescents
Insights
This study analyzed 38 pediatric cases of symptomatic cerebral aneurysms and subarachnoid hemorrhage. Key findings highlight common locations and age-related differences in presentation and outcomes for pediatric aneurysm patients.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Vascular Neurology
Background:
- Cerebral aneurysms and spontaneous subarachnoid hemorrhage (SAH) are rare in children and adolescents.
- This cohort represents 2.6% of all SAH patients treated at the institute during the study period.
Purpose of the Study:
- To investigate the characteristics, treatment, and outcomes of symptomatic cerebral aneurysms and SAH in pediatric patients.
- To identify age-specific patterns in aneurysm location and associated complications.
Main Methods:
- Retrospective review of 38 pediatric cases (1965-1984) with symptomatic cerebral aneurysms or SAH.
- Analysis of aneurysm location, etiology, clinical presentation, treatment modalities, and patient outcomes.
Main Results:
- 29 ruptured aneurysms, 7 unknown SAH causes, 2 unruptured symptomatic aneurysms.
- Common locations: internal carotid bifurcation, anterior communicating artery, middle cerebral artery branches.
- Younger children (<3 years) had unique features and MCA aneurysms; older children (10-15 years) had more internal carotid bifurcation aneurysms and intracerebral hematomas; adolescents (16-20 years) had more anterior communicating artery aneurysms with fewer hematomas.
- Surgical clipping in 19 patients resulted in 10% morbidity and 5% mortality.
Conclusions:
- Pediatric cerebral aneurysms and SAH exhibit distinct epidemiological and clinical features compared to adults.
- Age is a significant factor influencing aneurysm location and the likelihood of intracerebral hematoma formation.
- Surgical intervention for pediatric aneurysms carries notable risks, underscoring the need for careful management strategies.
Abstract:
Thirty-eight cases of symptomatic cerebral aneurysms or spontaneous subarachnoid hemorrhage in children and adolescents were observed from 1965 to 1984; 33 cases were treated from 1970 to date. This group represents 2.6% of the total number of patients with subarachnoid hemorrhage treated at our institute in the same period. The cause of subarachnoid hemorrhage was unknown in 7 cases; an intracranial aneurysm had ruptured in 29 cases, and was unruptured but symptomatic in 2 remaining cases. Three aneurysms were mycotic. The most frequent aneurysmal locations were the internal carotid bifurcation and the anterior communicating artery; peripheral branches of the middle cerebral artery were also a relatively common location. Four patients were 3 years of age or younger: each presented peculiar clinical features, and 3 of the 4 had middle cerebral artery aneurysms. The remaining 34 patients were all above 9 years of age. Two groups were identified: (a) in 14 patients between 10 and 15 years of age, the aneurysm was most commonly at the internal carotid bifurcation (37%), and an intracerebral hematoma was observed in 50% of these cases; (b) in 20 patients between 16 and 20 years of age, the most common aneurysmal location was the anterior communicating artery (35%), and intracerebral hematomas were rare (10% of cases). Among patients with aneurysms, 19 underwent surgical exclusion by clip, with 10% morbidity and 5% mortality; 5 patients in moribund conditions were not operated on; 5 patients were conservatively treated; in 2 patients the aneurysm had disappeared at a second angiography.(ABSTRACT TRUNCATED AT 250 WORDS)