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Original research
Locations, associations and temporal evolution of intracranial arterial infundibular dilatations in children
  1. Adam A Dmytriw1,
  2. Daniel-Alexandre Bisson1,
  3. Kevin Phan1,
  4. Afsaneh Amirabadi1,
  5. Helen Branson1,
  6. Peter B Dirks2,
  7. Manohar Shroff1,
  8. Prakash Muthusami1
  1. 1Department of Diagnostic Imaging & Image Guided Therapy, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
  2. 2Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
  1. Correspondence to Dr Adam A Dmytriw, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada; adam.dmytriw{at}sickkids.ca

Abstract

Background There are few data in the literature on the characteristics and natural history of intracranial arterial infundibular dilatations in children.

Methods An institutional review board-approved retrospective review was performed of infundibula reported on MR angiography in patients <18 years of age at our tertiary pediatric institute from 1998 to 2016. Clinical data (age, sex, diagnosis, other vascular variants/pathologies) were recorded and images assessed for vessel of origin, infundibulum size and exact location. Ratios of infundibulum:parent artery were assessed at diagnosis and last follow-up. Temporal evolution to aneurysm was evaluated.

Results We found 60 intracranial infundibula in 60 children (male:female=27:33; mean age 9.7±5.2 years, range 2–18 years,). Family history of aneurysms was present in 2/60 (3.3%). Syndromic association was found in 14/60 (23.3%), most frequently sickle cell disease (4/14=28.6%). Mean infundibulum size was 2.2±0.5 mm, with mean ratio to parent artery of 0.54±0.17. The most common location was on the P1-posterior cerebral artery (34/63=56.7%), whereas posterior communicating infundibula were seen in only 4/60 (6.7%) cases. Other cerebrovascular variants were seen in 12/60 (20%) patients. On follow-up imaging (in 32/60 patients over 86 patient-years, mean 32.3±35.7 months), no significant change in infundibulum:parent artery ratio was noted. None of the infundibular dilatations showed interval evolution to aneurysm.

Conclusion We present the largest reported cohort of pediatric intracranial arterial infundibula, which we found to be distinct from their adult counterparts with regard to location, etiology and temporal evolution. Growth over time and/or aneurysmal formation are rare, not necessitating frequent short-term imaging surveillance during childhood.

  • aneurysm
  • magnetic resonance angiography
  • pediatrics
  • subarachnoid
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Footnotes

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  • Contributors AAD and DAB made substantial contributions to the conception and design of the work, data acquisition, and analysis. KP and PM made substantial contributions to the conception and design of the work, data acquisition, analysis and interpretation, and drafting of the work. AA, HB, MMS and PD made substantial contributions to the conception and design of the work and revising it critically for important intellectual content. All authors gave final approval of the version to be published and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Institutional Research Ethics Board (REB# 1000056549).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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