Skip to main content
Top
Published in: Acta Neurochirurgica 8/2018

01-08-2018 | Original Article - Pediatric Neurosurgery

Pediatric intracranial distal arterial aneurysms: report of 35 cases

Authors: Ruiqi Chen, Si Zhang, Rui Guo, Lu Ma, Chao You

Published in: Acta Neurochirurgica | Issue 8/2018

Login to get access

Abstract

Background

Although research on pediatric intracranial aneurysms is well documented, studies of pediatric intracranial distal arterial aneurysms (PIDAAs) remain scarce.

Methods

All pediatric patients (≤ 18 years) with intracranial aneurysms located distally to the M2 segment of the middle cerebral artery (MCA), A2 segment of the anterior cerebral artery, P2 segment of the posterior cerebral artery, and other cerebral arteries distal to the main branch who were treated at our center between January 2012 and April 2017 were retrospectively reviewed.

Results

Thirty-five PIDAAs were observed in 35 patients with a mean age of 9.2 ± 5.9 years and a male ratio of 71.4% (n = 25). Sudden onset of severe headache was the most common symptom (n = 22, 62.9%), followed by seizures (n = 21, 60%). Twenty-seven patients (77.1%) had ruptured aneurysms, and 18 of them (66.7%) exhibited combined lobe intracerebral hematoma. MCA was the most common site (n = 23, 65.7%). Large or giant aneurysms were observed in 16 patients (45.7%). Eight patients (22.9%) had pseudoaneurysms, six of whom (75%) reported a head trauma history. Thirty patients (85.7%) had favorable outcomes at the end of the 6-month follow-up. Kaplan-Meier 6-month seizure curves revealed a significantly higher decrease in seizure rates in the surgical group than in the endovascular group (P = 0.036).

Conclusions

PIDAAs constitute a high proportion of pediatric intracranial aneurysms. PIDAAs are associated with an increased risk of seizures, a predilection for the MCA, and a high incidence of pseudoaneurysms with head trauma history. Surgical intervention is of greater benefit than endovascular treatment in controlling the risk of seizures.
Literature
5.
go back to reference Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P, American Heart Association Stroke C, Council on Cardiovascular R, Intervention, Council on Cardiovascular N, Council on Cardiovascular S, Anesthesia, Council on Clinical C (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43:1711–1737. https://doi.org/10.1161/STR.0b013e3182587839 CrossRefPubMed Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, Hoh BL, Kirkness CJ, Naidech AM, Ogilvy CS, Patel AB, Thompson BG, Vespa P, American Heart Association Stroke C, Council on Cardiovascular R, Intervention, Council on Cardiovascular N, Council on Cardiovascular S, Anesthesia, Council on Clinical C (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 43:1711–1737. https://​doi.​org/​10.​1161/​STR.​0b013e3182587839​ CrossRefPubMed
13.
14.
go back to reference Heiskanen O (1989) Ruptured intracranial arterial aneurysms of children and adolescents. Surgical and total management results. Childs Nerv Syst 5:66–70CrossRefPubMed Heiskanen O (1989) Ruptured intracranial arterial aneurysms of children and adolescents. Surgical and total management results. Childs Nerv Syst 5:66–70CrossRefPubMed
20.
go back to reference Leibrock LG, Bennett DR, Bloch S (1983) Complex partial seizures associated with unruptured thrombosed basilar artery apex aneurysm. Surg Neurol 19:17–20CrossRefPubMed Leibrock LG, Bennett DR, Bloch S (1983) Complex partial seizures associated with unruptured thrombosed basilar artery apex aneurysm. Surg Neurol 19:17–20CrossRefPubMed
27.
go back to reference Meljnikov I, Vulekovic P, Cigic T, Borisev V, Milojevic A, Iduski S (2012) Treatment of pediatric patient with ruptured intracranial aneurysm—case report. Med Pregl 65:331–336CrossRefPubMed Meljnikov I, Vulekovic P, Cigic T, Borisev V, Milojevic A, Iduski S (2012) Treatment of pediatric patient with ruptured intracranial aneurysm—case report. Med Pregl 65:331–336CrossRefPubMed
29.
go back to reference Motohashi O, Kameyama M, Imaizumi S, Mino M, Naganuma H, Ishii K, Onuma T (2004) A distal anterior cerebral artery aneurysm in infant: disappearance and reappearance of the aneurysm. J Clin Neurosci 11:86–88CrossRefPubMed Motohashi O, Kameyama M, Imaizumi S, Mino M, Naganuma H, Ishii K, Onuma T (2004) A distal anterior cerebral artery aneurysm in infant: disappearance and reappearance of the aneurysm. J Clin Neurosci 11:86–88CrossRefPubMed
33.
go back to reference Raju BS, Purohit AK, Murthy SR, Sundaram C, Sanjay T (2001) Traumatic distal anterior cerebral artery aneurysm in a child: a case report. Neurol India 49:295–298PubMed Raju BS, Purohit AK, Murthy SR, Sundaram C, Sanjay T (2001) Traumatic distal anterior cerebral artery aneurysm in a child: a case report. Neurol India 49:295–298PubMed
34.
go back to reference Rhoney DH, Tipps LB, Murry KR, Basham MC, Michael DB, Coplin WM (2000) Anticonvulsant prophylaxis and timing of seizures after aneurysmal subarachnoid hemorrhage. Neurology 55:258–265CrossRefPubMed Rhoney DH, Tipps LB, Murry KR, Basham MC, Michael DB, Coplin WM (2000) Anticonvulsant prophylaxis and timing of seizures after aneurysmal subarachnoid hemorrhage. Neurology 55:258–265CrossRefPubMed
38.
go back to reference Thompson BG, Brown RD Jr, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES Jr, Duckwiler GR, Harris CC, Howard VJ, Johnston SC, Meyers PM, Molyneux A, Ogilvy CS, Ringer AJ, Torner J, American Heart Association Stroke Council CoC, Stroke N, Council on E, Prevention, American Heart A, American Stroke A (2015) Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46:2368–2400. https://doi.org/10.1161/STR.0000000000000070 CrossRefPubMed Thompson BG, Brown RD Jr, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES Jr, Duckwiler GR, Harris CC, Howard VJ, Johnston SC, Meyers PM, Molyneux A, Ogilvy CS, Ringer AJ, Torner J, American Heart Association Stroke Council CoC, Stroke N, Council on E, Prevention, American Heart A, American Stroke A (2015) Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46:2368–2400. https://​doi.​org/​10.​1161/​STR.​0000000000000070​ CrossRefPubMed
40.
go back to reference Wojtacha M, Bazowski P, Mandera M, Krawczyk I, Rudnik A (2001) Cerebral aneurysms in childhood. Childs Nerv Syst 17:37–41CrossRefPubMed Wojtacha M, Bazowski P, Mandera M, Krawczyk I, Rudnik A (2001) Cerebral aneurysms in childhood. Childs Nerv Syst 17:37–41CrossRefPubMed
42.
go back to reference Young WF, Pattisapu JV (2000) Ruptured cerebral aneurysm in a 39-day-old infant. Clin Neurol Neurosurg 102:140–143CrossRefPubMed Young WF, Pattisapu JV (2000) Ruptured cerebral aneurysm in a 39-day-old infant. Clin Neurol Neurosurg 102:140–143CrossRefPubMed
Metadata
Title
Pediatric intracranial distal arterial aneurysms: report of 35 cases
Authors
Ruiqi Chen
Si Zhang
Rui Guo
Lu Ma
Chao You
Publication date
01-08-2018
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 8/2018
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-018-3574-0

Other articles of this Issue 8/2018

Acta Neurochirurgica 8/2018 Go to the issue