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Endovascular treatment of pediatric intracranial aneurysms: a retrospective study of 35 aneurysms
  1. Koichiro Takemoto,
  2. Satoshi Tateshima,
  3. Ali Golshan,
  4. Nestor Gonzalez,
  5. Reza Jahan,
  6. Gary Duckwiler,
  7. Fernando Vinuela
  1. Division of Interventional Neuroradiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
  1. Correspondence to Dr Satoshi Tateshima, Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza Suite 2129, Box 743730, Los Angeles, CA 90095, USA; stateshima{at}mednet.ucla.edu

Abstract

Background Pediatric intracranial aneurysms are rare and not well characterized in comparison with those in adults.

Objective To analyze our institution’s longitudinal experience of endovascular treatment for pediatric aneurysms to better understand this rare condition.

Methods A retrospective record review was performed of patients aged <20 years treated with endovascular methods for intracranial aneurysms between 1995 and 2012. There were 31 patients (average 14.4±4.2 years; 20 male, 11 female) with 35 intracranial aneurysms.

Results The rate of subarachnoid hemorrhage as the initial presentation was 48% and the rates of multiple and giant aneurysms were 13% and 31%, respectively; 28.5% of the cases were posterior circulation aneurysms. Fifteen saccular aneurysms occurred in 14 patients and 17 fusiform aneurysms were noted in 14 patients. Two infectious aneurysms were diagnosed in two patients and one traumatic aneurysm occurred in another patient. Thirty-four aneurysms were treated endovascularly and one had thrombosed spontaneously on a follow-up angiogram. Of the 15 saccular aneurysms, 11 were treated with conventional coiling, one was treated with stent-assisted coiling, one was treated with a flow-diverting stent and two were treated with parent vessel occlusion (PVO). Of the 17 fusiform aneurysms, 15 were treated with PVO with or without prior bypass surgery and one was treated with a flow-diverting stent. The rate of permanent complications and a favorable outcome were 2.9% and 87%, respectively.

Conclusions Endovascular treatment of pediatric aneurysms is technically feasible with an acceptable complication rate despite the high incidence of fusiform aneurysms.

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