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Intracranial aneurysms in infants and children
J W Allison1, P C Davis, Y Sato
1University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Insights
Pediatric aneurysms vary in type, location, and size, often appearing in the posterior fossa. Advanced imaging like CT, MR, and MRA aids diagnosis, with angiography crucial for surgical planning.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Vascular Surgery
Background:
- Pediatric aneurysm diagnosis and imaging have evolved with Magnetic Resonance (MR) and MR Angiography (MRA).
- Understanding current diagnostic approaches is vital for effective management.
Purpose of the Study:
- To provide an updated literature review on pediatric aneurysms.
- To define optimal diagnostic work-up strategies for childhood aneurysms.
Main Methods:
- Retrospective review of 25 aneurysms in 21 children across three institutions over 20 years.
- Utilized various imaging modalities including CT, MR, MRA, and conventional angiography.
Main Results:
- Aneurysms were predominantly congenital saccular (18/25), with a significant proportion in the posterior circulation (44%).
- Many aneurysms were large (40%) or giant (16%), often arising from distal arteries.
- CT and MR detected hemorrhage and visualized aneurysms; MRA identified aneurysms in 4 out of 6 patients.
Conclusions:
- Pediatric aneurysms exhibit diverse characteristics, including posterior fossa prevalence, peripheral location, and large size.
- CT, MR, and MRA are valuable diagnostic tools.
- Conventional angiography remains essential for preoperative planning.
Background:
The diagnosis and imaging of pediatric aneurysms has changed since the advent of MR and MRA.
Objective:
To update the literature on pediatric aneurysms and better define the appropriate work-up of childhood aneurysms in 1997.
Materials And Methods:
Retrospective review of 21 children (12 boys, 9 girls) with 25 aneurysms from three institutions over a 20-year period was performed. Imaging studies were mixed and included CT (19 patients), MR (11 patients), MRA (6 patients) and angiography (18 patients).
Results:
Eighteen of 25 aneurysms were congenital saccular, 6 were mycotic, and 1 was post-traumatic. Of these, 44 % were in the posterior circulation. Nine aneurysms arose from distal arterial branches. Forty percent were large (between 1-2.5 cm) and 16 % were giant (> 2.5 cm). CT and MR showed hemorrhage, and frequently revealed the aneurysms as a focal mass with or without enhancement and flow void. Six children had MRA which revealed aneurysms in four patients. All patients with MRA had corresponding conventional angiography.
Conclusion:
Characteristics of pediatric aneurysms include diversity of type, increased incidence in the posterior fossa, peripheral location, and large size. CT, MR and MRA are useful in the diagnosis with conventional angiography essential for preoperative planning.