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Intracranial arterial aneurysms in children and adolescents
Insights
Pediatric intracranial arterial aneurysms are treatable with direct clipping, showing good outcomes in 80% of cases. Cognitive deficits, particularly memory retrieval, may persist post-surgery.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Vascular Neurology
Background:
- Subarachnoid hemorrhage (SAH) in children due to intracranial arterial aneurysms is rare but serious.
- Early diagnosis and effective treatment are crucial for favorable outcomes.
Purpose of the Study:
- To report outcomes of surgical management for intracranial arterial aneurysms in pediatric patients (0-19 years).
- To evaluate the efficacy of different surgical techniques and identify factors influencing outcomes.
Main Methods:
- Retrospective review of 32 pediatric patients with ruptured intracranial arterial aneurysms.
- Surgical interventions included direct intracranial clipping, proximal clipping, wrapping, and carotid ligation.
- Outcomes assessed by neurological deficit, work/school capacity, and neuropsychological testing.
Main Results:
- Direct intracranial clipping was the most common and preferred method.
- Surgical mortality was 3.1% (1 death).
- 80% of patients achieved good outcomes with no neurological deficits.
- Neuropsychological testing revealed memory retrieval deficits in some patients, though often not impacting daily function.
Conclusions:
- Direct intracranial clipping is the preferred surgical approach for pediatric intracranial aneurysms.
- While surgical outcomes are generally good, subtle cognitive deficits, particularly in memory, warrant further investigation.
- Pediatric patients tolerate surgery well, but operative timing and patient condition (avoiding coma) are critical.
Abstract:
This is a report on 32 patients with subarachnoid haemorrhage caused by rupture of an intracranial arterial aneurysm in the 0-19 age group. Sixteen of the aneurysms were situated in the bifurcation of the internal carotid artery, 8 in the anterior communicating artery, 4 in the posterior communicating artery, two in PICA, one in the middle cerebral artery, and one in the pericallosal artery. Direct intracranial clipping of the neck of the aneurysm was carried out in 26 cases, proximal clipping in three, wrapping in two, and common carotid ligation in one case. There was one death from surgery. The surgical mortality was thus 3.1%. In 80% of cases the result was good, i.e., the patient had no neurological deficit and was able to work or continue at normal school. The psychological tests indicated some cognitive deficits in aneurysm patients as compared to the control patients. The common feature of these deficits seemed to be an impairment of active retrieval and searching of memory, while common cognitive skills were usually preserved. Four of the five patients who were disabled had obvious deficits in their performances. In the other patients these deficits did not affect their capacity for work or studies, and they were usually unaware of them. Children seem to tolerate surgery better than adults. Comatose or drowsy patients should not be operated on. The operative method of choice is direct intracranial clipping of the neck of the aneurysm.