Pediatric Posterior Circulation Aneurysms: A Distinct Entity Treated with Flow Diversion

Flow diversion has transformed the treatment of intracranial aneurysms; however, data on pediatric posterior circulation aneurysms remain limited. The purpose of this study is to evaluate flow diversion in pediatric intracranial posterior circulation aneurysms.

Pediatric intracranial posterior circulation aneurysms treated by flow diverters in a tertiary referral center between 2014 and 2025 were identified and reviewed retrospectively for patient characteristics, angiographic and clinical results of flow diversion.

During this period, all the 11 children (6 boys, median age: 14; age range: 6 - 19) who presented with 15 pediatric intracranial posterior circulation aneurysms were treated with flow diversion. Their aneurysms were of fusiform/dissecting type, yet, distinct from the dolichoectatic forms of the vertebrobasilar aneurysms as seen in adults. Two of them had bled previously. The median size/length of the index aneurysms (larger aneurysm in case of tandem aneurysms) was 27 mm and three of them were classified as complex aneurysms demanding multi-device endovascular arterial reconstructions. All embolization procedures were technically successful, without any procedure-related permanent neurological morbidity or mortality on follow-up. One child died because of the consequences of her underlying disease. At a median imaging follow-up of 47 months (3 - 89 months), residual opacification remained in one aneurysm (9.1% of patients, 6.7% of aneurysms) whereas infundibular opacification of efferent arteries was noted in 2 children.

In this single-center series, pediatric posterior circulation aneurysms treated with flow diversion were predominantly large or giant fusiform/dissecting lesions requiring individualized reconstructive strategies. Flow diversion was technically feasible and associated with favorable long-term angiographic and clinical outcomes in this cohort. Flow diversion represents a viable option for these aneurysms.