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Ruptured distal middle cerebral artery aneurysm in a pediatric patient: illustrative case
Jonathan Espinosa1, Gregory Murtha1, Samon Tavakoli2
1Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas.
Insights
Pediatric intracranial aneurysms are rare and may differ from adult cases. This study details a 7-year-old boy with a distal middle cerebral artery aneurysm treated with open surgery due to hemorrhage.
Area of Science:
- Pediatric Neurosurgery
- Cerebrovascular Surgery
Background:
- Pediatric intracranial aneurysms (IAs) are uncommon, accounting for <5% of all IAs.
- Pathology and management of pediatric IAs may differ from adults.
- A case of a large, partially thrombosed distal middle cerebral artery (MCA) aneurysm in a 7-year-old is presented.
Purpose of the Study:
- To report a rare case of pediatric intracranial aneurysm with intraparenchymal hemorrhage.
- To discuss the management considerations for pediatric aneurysms.
Main Methods:
- A 7-year-old male presented with left hemiparesis and right frontal intraparenchymal hemorrhage (IPH) on CT.
- Digital subtraction angiography (DSA) confirmed a large, partially thrombosed distal MCA aneurysm.
- Surgical treatment involved right frontal craniotomy for aneurysm clipping, excision, and hematoma evacuation, with intraoperative DSA confirmation.
Main Results:
- The patient underwent successful surgical intervention.
- At 6-month follow-up, the patient returned to his neurological baseline.
- Annual cerebrovascular radiographic surveillance is ongoing.
Conclusions:
- Pediatric aneurysms with IPH are rare, necessitating specific diagnostic and treatment approaches.
- Open surgical intervention was chosen due to IPH and distal aneurysm location.
- Etiology of pediatric aneurysms may differ from adults, requiring tailored management strategies.
Background:
Pediatric intracranial aneurysms (IAs) are rare, with an estimated occurrence of less than 5% of all IAs. The pathology of pediatric aneurysms may differ from adult IAs and require additional workup. Management options for pediatric aneurysms include both endovascular and open procedures. The authors report the case of a 7-year-old male with a large, partially thrombosed distal middle cerebral artery (MCA) aneurysm.
Observations:
The patient presented with left hemiparesis. The initial CT imaging showed an intraparenchymal hemorrhage (IPH) in the right frontal lobe. Digital subtraction angiography (DSA) showed a large, partially thrombosed distal MCA aneurysm. A right frontal craniotomy was performed for aneurysm clipping, excision, and hematoma evacuation. Intraoperative DSA was utilized to confirm the absence of residual aneurysm. At the 6-month follow-up appointment, the patient had returned to his neurological baseline. He continues annual cerebrovascular radiographic surveillance.
Lessons:
Pediatric aneurysms presenting with IPH are exceedingly rare. In this patient, an open surgical intervention was favored due to the presence of an IPH and the distal location of the aneurysm. Pediatric aneurysms may have a different etiology than that of adults. Because of this difference, these lesions require special considerations with regard to workup and treatment. https://thejns.org/doi/10.3171/CASE24373.
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