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World Neurosurg. 2019 Feb 19. pii: S1878-8750(19)30399-7. doi: 10.1016/j.wneu.2019.01.280. [Epub ahead of print]

Pediatric Intracranial Aneurysms: Favorable Outcomes Despite Rareness and Complexity.

Author information

1
Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
2
Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
3
Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: elevenes@gmail.com.

Abstract

OBJECTIVE:

Pediatric intracranial aneurysms (IAs) are rare and differ from their adult counterparts in terms of their aneurysmal characteristics, presentation, treatment, and outcomes. Their treatment is often more difficult and complex compared with that of adults. However, studies outlining the clinical effect of pediatric IAs remain sparse.

METHODS:

We retrospectively reviewed the data from patients aged ≤18 years admitted to our hospital from 2000 to 2017 with a diagnosis of IAs.

RESULTS:

From the sample of 8207 patients with an IA diagnosis, 26 patients with 33 IAs were involved. Our cohort included 17 males and 9 females, with a mean age of 12.5 years. The mean follow-up duration was 4 years and 3 months. Seven patients (26.92%) were assumed to have a traumatic origin for their IAs. Ruptured aneurysms were more common than unruptured ones (61.53% vs. 38.46%). Complex features were observed in 14 aneurysms (42.42%). Initially, microsurgical and endovascular treatment were both performed in 10 patients (38.46%). A good recovery was obtained in 16 patients (61.54%) as determined by the Glasgow outcome scale scores at the 6-month follow-up visits. The complete obliteration of aneurysms was observed in 17 patients (65.38%). Endovascular treatment was the initial treatment in 3 patients with incomplete obliteration.

CONCLUSIONS:

The treatment of pediatric IAs is challenging and technically demanding owing to their discrete nature compared with adult IAs and the need for greater surgical skills. We found a male predominance, with internal carotid artery bifurcation as the most frequent location of the aneurysms. Despite the greater incidence of ruptured and complex aneurysm cases, many patients had experienced a good recovery at the 6-month follow-up examinations.

KEYWORDS:

Adolescent; Aneurysm; Child; Endovascular treatment; Intracranial aneurysm; Pediatric; Surgery

PMID:
30794975
DOI:
10.1016/j.wneu.2019.01.280

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