E-057 Endovascular management of pediatric aneurysms
Object Although the general principles of endovascular aneurysm treatment in adults hold true in children, these young patients pose unique challenges: small anatomy, longer life expectancy, associated conditions and unique morphological characteristics of the aneurysms.
A few publications in literature have addressed the role of endovascular treatment for pediatric aneurysms. These include series by Agid et al (2005) revisiting the Toronto series (Laughlin et al 1997), Lasjaunias et al (2005) updating the Bicêtre series (Lasjaunias et al 1997) and Nader et al presenting the San Francisco series (2006). In their conclusions, the authors of the former two publications favored endovascular treatment over microsurgery. On the other hand, the authors of the later publication favored microsurgery over endovascular treatment.
The authors reviewed Louisiana State University experience regarding endovascular treatment of pediatric aneurysms focusing on outcomes.
Methods A retrospective chart review of children under 18 years of age who underwent endovascular treatment for intracranial aneurysms between 2000 and 2009 in our institution was undertaken. 12 patients harboring 17 aneurysms were identified. The patients ranged in age from 17 months to 17 years. Complete aneurysm obliteration following endovascular treatment was 90%. Our results showed unique features for pediatric aneurysms compared with adult aneurysms. There was no intraoperative mortality.
One aneurysm recurred (5% recurrence rate among total number of aneurysms). Six months after treatment, a control angiogram showed that the coils displaced towards the dome of the recurred aneurysm. This recurrence occurred before the introduction of the hydro coils. One patient died during the postintervention period (8% recurrence rate among total number of patients).
Outcomes were better in anterior circulation aneurysms than in posterior circulation lesions. We had no mortality, morbidity or disability in the anterior circulation aneurysm group. In the posterior circulation group, there was one death representing 14% of the nine patients with aneurysms in this group. One recurrence occurred in the posterior circulation group representing 11% of the nine aneurysms in this group. The follow-up of all patients ranged from 2 to 8 years.
Conclusion Endovascular treatment of pediatric intracranial aneurysm is safe and efficacious. The endovascular treatment in many instances provides less morbidity and mortality for treatment of pediatric aneurysms in inaccessible or eloquent locations than microsurgical clipping. The result of endovascular treatment depends on the location of the aneurysms and the underlying pathology. We advocate a multidisciplinary approach when choosing the therapeutic modality for treatment of pediatric aneurysms.
Competing interests None.