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Published in: Child's Nervous System 4/2013

01-04-2013 | Case Report

Management of ruptured dissecting intracranial aneurysms in infants: report of four cases and review of the literature

Authors: Vikas Y. Rao, Krishna B. Shah, Robert J. Bollo, Michel E. Mawad, William E. Whitehead, Daniel J. Curry, Robert C. Dauser, Thomas G. Luerssen, Andrew Jea

Published in: Child's Nervous System | Issue 4/2013

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Abstract

Backgound

Intracranial cerebral aneurysms in the pediatric population are infrequent, and those occurring in infants less than 1 year old are extremely rare. Of intracranial aneurysms in children, dissecting aneurysms are the most common type seen. While spontaneous dissecting aneurysms usually present with ischemia, hemorrhage can also occur.

Methods

A retrospective review of our patients revealed that from July 1, 2007 to June 30, 2012, four infants were treated for ruptured distal dissecting intracranial aneurysms at Texas Children’s Hospital. Mycotic aneurysms and collagen vascular disorder were excluded in all four cases. All patients presented in our series presented with subarachnoid hemorrhage, and three had intraventricular hemorrhage. All patients underwent conventional catheter angiography for diagnosis. All patients in this series were managed in the acute or subacute period with surgical or endovascular trapping without distal bypass procedures. All four patients tolerated sacrifice of the parent vessels feeding these distal aneurysms well.

Case report and review of literature

We describe the presentation and management of these rare cases and then review the current literature on the management of these dissecting aneurysms in infants.
Literature
1.
go back to reference Anson JA, Lawton MT, Spetzler RF (1996) Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 84:185–193PubMedCrossRef Anson JA, Lawton MT, Spetzler RF (1996) Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 84:185–193PubMedCrossRef
2.
go back to reference Biffl WL, Moore EE, Offner PJ, Burch JM (2001) Blunt carotid and vertebral arterial injuries. World J Surg 25:1036–1043PubMedCrossRef Biffl WL, Moore EE, Offner PJ, Burch JM (2001) Blunt carotid and vertebral arterial injuries. World J Surg 25:1036–1043PubMedCrossRef
3.
go back to reference Brandt T, Hausser I, Orberk E, Grau A, Hartschuh W, Anton-Lamprecht I, Hacke W (1998) Ultrastructural connective tissue abnormalities in patients with spontaneous cervicocerebral artery dissections. Ann Neurol 44:281–285PubMedCrossRef Brandt T, Hausser I, Orberk E, Grau A, Hartschuh W, Anton-Lamprecht I, Hacke W (1998) Ultrastructural connective tissue abnormalities in patients with spontaneous cervicocerebral artery dissections. Ann Neurol 44:281–285PubMedCrossRef
4.
go back to reference Brandt T, Orberk E, Weber R, Werner I, Busse O, Müller BT, Wigger F, Grau A, Grond-Ginsbach C, Hausser I (2001) Pathogenesis of cervical artery dissections: association with connective tissue abnormalities. Neurology 57:24–30PubMedCrossRef Brandt T, Orberk E, Weber R, Werner I, Busse O, Müller BT, Wigger F, Grau A, Grond-Ginsbach C, Hausser I (2001) Pathogenesis of cervical artery dissections: association with connective tissue abnormalities. Neurology 57:24–30PubMedCrossRef
5.
go back to reference Buckingham MJ, Crone KR, Ball WS, Tomsick TA, Berger TS, Tew JM (1988) Traumatic intracranial aneurysms in childhood: two cases and a review of the literature. Neurosurgery 22:398–408PubMedCrossRef Buckingham MJ, Crone KR, Ball WS, Tomsick TA, Berger TS, Tew JM (1988) Traumatic intracranial aneurysms in childhood: two cases and a review of the literature. Neurosurgery 22:398–408PubMedCrossRef
6.
go back to reference Day AL, Gaposchkin CG, Yu CJ, Rivet DJ, Dacey RG (2003) Spontaneous fusiform middle cerebral artery aneurysms: characteristics and a proposed mechanism of formation. J Neurosurg 99:228–240PubMedCrossRef Day AL, Gaposchkin CG, Yu CJ, Rivet DJ, Dacey RG (2003) Spontaneous fusiform middle cerebral artery aneurysms: characteristics and a proposed mechanism of formation. J Neurosurg 99:228–240PubMedCrossRef
7.
go back to reference Fleischer AS, Patton JM, Tindall GT (1975) Cerebral aneurysms of traumatic origin. Surg Neurol 4:233–239PubMed Fleischer AS, Patton JM, Tindall GT (1975) Cerebral aneurysms of traumatic origin. Surg Neurol 4:233–239PubMed
8.
go back to reference Han MH, Sung MW, Chang KH, Min YG, Han DH, Han MC (1994) Traumatic pseudoaneurysm of the intracavernous ICA presenting with massive epistaxis: imaging diagnosis and endovascular treatment. Laryngoscope 104:370–377PubMedCrossRef Han MH, Sung MW, Chang KH, Min YG, Han DH, Han MC (1994) Traumatic pseudoaneurysm of the intracavernous ICA presenting with massive epistaxis: imaging diagnosis and endovascular treatment. Laryngoscope 104:370–377PubMedCrossRef
9.
go back to reference Hoit DA, Schirmer CM, Weller SJ, Lisbon A, Edlow JA, Malek AM (2008) Angiographic detection of carotid and vertebral arterial injury in the high-energy blunt trauma patient. J Spinal Disord Tech 21:259–266PubMedCrossRef Hoit DA, Schirmer CM, Weller SJ, Lisbon A, Edlow JA, Malek AM (2008) Angiographic detection of carotid and vertebral arterial injury in the high-energy blunt trauma patient. J Spinal Disord Tech 21:259–266PubMedCrossRef
10.
go back to reference Huang J, Mcgirt MJ, Gailloud P, Tamargo RJ (2005) Intracranial aneurysms in the pediatric population: case series and literature review. Surg Neurol 63:424–432, discussion 432–423PubMedCrossRef Huang J, Mcgirt MJ, Gailloud P, Tamargo RJ (2005) Intracranial aneurysms in the pediatric population: case series and literature review. Surg Neurol 63:424–432, discussion 432–423PubMedCrossRef
11.
go back to reference Isono M, Abe T, Goda M, Ishii K, Kobayashi H (2002) Middle cerebral artery dissecting aneurysm causing intracerebral hemorrhage 4 years after the non-hemorrhagic onset: a case report. Surg Neurol 57:346–349, discussion 349–350PubMedCrossRef Isono M, Abe T, Goda M, Ishii K, Kobayashi H (2002) Middle cerebral artery dissecting aneurysm causing intracerebral hemorrhage 4 years after the non-hemorrhagic onset: a case report. Surg Neurol 57:346–349, discussion 349–350PubMedCrossRef
12.
go back to reference Krishna H, Wani AA, Behari S, Banerji D, Chhabra DK, Jain VK (2005) Intracranial aneurysms in patients 18 years of age or under, are they different from aneurysms in adult population? Acta Neurochir (Wien) 147:469–476, discussion 476CrossRef Krishna H, Wani AA, Behari S, Banerji D, Chhabra DK, Jain VK (2005) Intracranial aneurysms in patients 18 years of age or under, are they different from aneurysms in adult population? Acta Neurochir (Wien) 147:469–476, discussion 476CrossRef
13.
go back to reference Larson PS, Reisner A, Morassutti DJ, Abdulhadi B, Harpring JE (2000) Traumatic intracranial aneurysms. Neurosurg Focus 8:e4PubMedCrossRef Larson PS, Reisner A, Morassutti DJ, Abdulhadi B, Harpring JE (2000) Traumatic intracranial aneurysms. Neurosurg Focus 8:e4PubMedCrossRef
14.
go back to reference Lasjaunias P, Wuppalapati S, Alvarez H, Rodesch G, Ozanne A (2005) Intracranial aneurysms in children aged under 15 years: review of 59 consecutive children with 75 aneurysms. Childs Nerv Syst 21:437–450PubMedCrossRef Lasjaunias P, Wuppalapati S, Alvarez H, Rodesch G, Ozanne A (2005) Intracranial aneurysms in children aged under 15 years: review of 59 consecutive children with 75 aneurysms. Childs Nerv Syst 21:437–450PubMedCrossRef
15.
go back to reference Locksley HB (1966) Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. J Neurosurg 25:219–239, Section V, Part IPubMedCrossRef Locksley HB (1966) Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. J Neurosurg 25:219–239, Section V, Part IPubMedCrossRef
16.
go back to reference Malhotra AK, Camacho M, Ivatury RR, Davis IC, Komorowski DJ, Leung DA, Grizzard JD, Aboutanos MB, Duane TM, Cockrell C, Wolfe LG, Borchers CT, Martin NR (2007) Computed tomographic angiography for the diagnosis of blunt carotid/vertebral artery injury: a note of caution. Ann Surg 246:632–642, discussion 642–633PubMedCrossRef Malhotra AK, Camacho M, Ivatury RR, Davis IC, Komorowski DJ, Leung DA, Grizzard JD, Aboutanos MB, Duane TM, Cockrell C, Wolfe LG, Borchers CT, Martin NR (2007) Computed tomographic angiography for the diagnosis of blunt carotid/vertebral artery injury: a note of caution. Ann Surg 246:632–642, discussion 642–633PubMedCrossRef
17.
go back to reference Maroun F, Squarey K, Jacob J, Murray G, Cramer B, Barron J, Weir B (2003) Rupture of middle cerebral artery aneurysm in a neonate: case report and review of the literature. Surg Neurol 59:114–119PubMedCrossRef Maroun F, Squarey K, Jacob J, Murray G, Cramer B, Barron J, Weir B (2003) Rupture of middle cerebral artery aneurysm in a neonate: case report and review of the literature. Surg Neurol 59:114–119PubMedCrossRef
18.
go back to reference Martin JJ, Hausser I, Lyrer P, Busse O, Schwarz R, Schneider R, Brandt T, Kloss M, Schwaninger M, Engelter S, Grond-Ginsbach C (2006) Familial cervical artery dissections: clinical, morphologic, and genetic studies. Stroke J Cereb Circ 37:2924–2929CrossRef Martin JJ, Hausser I, Lyrer P, Busse O, Schwarz R, Schneider R, Brandt T, Kloss M, Schwaninger M, Engelter S, Grond-Ginsbach C (2006) Familial cervical artery dissections: clinical, morphologic, and genetic studies. Stroke J Cereb Circ 37:2924–2929CrossRef
19.
go back to reference Martin NA (1998) The combination of endovascular and surgical techniques for the treatment of intracranial aneurysms. Neurosurg Clin N Am 9:897PubMed Martin NA (1998) The combination of endovascular and surgical techniques for the treatment of intracranial aneurysms. Neurosurg Clin N Am 9:897PubMed
20.
go back to reference Oelerich M, Stögbauer F, Kurlemann G, Schul C, Schuierer G (1999) Craniocervical artery dissection: MR imaging and MR angiographic findings. Eur Radiol 9:1385–1391PubMedCrossRef Oelerich M, Stögbauer F, Kurlemann G, Schul C, Schuierer G (1999) Craniocervical artery dissection: MR imaging and MR angiographic findings. Eur Radiol 9:1385–1391PubMedCrossRef
21.
go back to reference Ohkuma H, Suzuki S, Shimamura N, Nakano T (2003) Dissecting aneurysms of the middle cerebral artery: neuroradiological and clinical features. Neuroradiology 45:143–148PubMed Ohkuma H, Suzuki S, Shimamura N, Nakano T (2003) Dissecting aneurysms of the middle cerebral artery: neuroradiological and clinical features. Neuroradiology 45:143–148PubMed
22.
go back to reference Ostergaard JR, Voldby B (1983) Intracranial arterial aneurysms in children and adolescents. J Neurosurg 58:832–837PubMedCrossRef Ostergaard JR, Voldby B (1983) Intracranial arterial aneurysms in children and adolescents. J Neurosurg 58:832–837PubMedCrossRef
23.
go back to reference Pasqualin A, Mazza C, Cavazzani P, Scienza R, DaPian R (1986) Intracranial aneurysms and subarachnoid hemorrhage in children and adolescents. Childs Nerv Syst 2:185–190PubMedCrossRef Pasqualin A, Mazza C, Cavazzani P, Scienza R, DaPian R (1986) Intracranial aneurysms and subarachnoid hemorrhage in children and adolescents. Childs Nerv Syst 2:185–190PubMedCrossRef
24.
go back to reference Patel AN, Richardson AE (1971) Ruptured intracranial aneurysms in the first two decades of life. A study of 58 patients. J Neurosurg 35:571–576PubMedCrossRef Patel AN, Richardson AE (1971) Ruptured intracranial aneurysms in the first two decades of life. A study of 58 patients. J Neurosurg 35:571–576PubMedCrossRef
25.
go back to reference Peron S, Jimenez-Roldán L, Cicuendez M, Millán JM, Ricoy JR, Lobato RD, Alday R, Alén JF, Lagares A (2010) Ruptured dissecting cerebral aneurysms in young people: report of three cases. Acta Neurochir (Wien) 152:1511–1517CrossRef Peron S, Jimenez-Roldán L, Cicuendez M, Millán JM, Ricoy JR, Lobato RD, Alday R, Alén JF, Lagares A (2010) Ruptured dissecting cerebral aneurysms in young people: report of three cases. Acta Neurochir (Wien) 152:1511–1517CrossRef
26.
go back to reference Proust F, Toussaint P, Garniéri J, Hannequin D, Legars D, Houtteville JP, Fréger P (2001) Pediatric cerebral aneurysms. J Neurosurg 94:733–739PubMedCrossRef Proust F, Toussaint P, Garniéri J, Hannequin D, Legars D, Houtteville JP, Fréger P (2001) Pediatric cerebral aneurysms. J Neurosurg 94:733–739PubMedCrossRef
27.
go back to reference Robertson WC, Given CA (2006) Spontaneous intracranial arterial dissection in the young: diagnosis by CT angiography. BMC Neurol 6:16PubMedCrossRef Robertson WC, Given CA (2006) Spontaneous intracranial arterial dissection in the young: diagnosis by CT angiography. BMC Neurol 6:16PubMedCrossRef
28.
go back to reference Sasaki O, Koike T, Tanaka R, Ogawa H (1991) Subarachnoid hemorrhage from a dissecting aneurysm of the middle cerebral artery. Case report. J Neurosurg 74:504–507PubMedCrossRef Sasaki O, Koike T, Tanaka R, Ogawa H (1991) Subarachnoid hemorrhage from a dissecting aneurysm of the middle cerebral artery. Case report. J Neurosurg 74:504–507PubMedCrossRef
29.
go back to reference Storrs BB, Humphreys RP, Hendrick EB, Hoffman HJ (1982) Intracranial aneurysms in the pediatric age-group. Childs Brain 9:358–361PubMed Storrs BB, Humphreys RP, Hendrick EB, Hoffman HJ (1982) Intracranial aneurysms in the pediatric age-group. Childs Brain 9:358–361PubMed
30.
go back to reference Tekkok IH (2005) Aneurysmal subarachnoid haemorrhage in the first year of life. Childs Nerv Syst 21:347–348, author reply 349PubMedCrossRef Tekkok IH (2005) Aneurysmal subarachnoid haemorrhage in the first year of life. Childs Nerv Syst 21:347–348, author reply 349PubMedCrossRef
Metadata
Title
Management of ruptured dissecting intracranial aneurysms in infants: report of four cases and review of the literature
Authors
Vikas Y. Rao
Krishna B. Shah
Robert J. Bollo
Michel E. Mawad
William E. Whitehead
Daniel J. Curry
Robert C. Dauser
Thomas G. Luerssen
Andrew Jea
Publication date
01-04-2013
Publisher
Springer-Verlag
Published in
Child's Nervous System / Issue 4/2013
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-012-1924-4

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