Aneurysm-PediatricIntracranial aneurysms in the pediatric population: case series and literature review
Introduction
Intracranial aneurysms are rare in the pediatric population, defined as patients 18 years old or younger, with a reported prevalence ranging from 0.5% to 4.6% [22], [48], [54], [56], [61], [65]. Only 41 of 6368 ruptured aneurysms were found in patients younger than 19 years in the Cooperative Study reported in 1966, with an incidence of only 0.6% [44]. In a multicenter series consisting entirely of children treated after 1986, they comprise 1% of all surgically aneurysms treated at 3 institutions in France during the same period [59]. It is estimated that most academic neurosurgical centers treat one pediatric aneurysm each year [51].
It appears that several epidemiological features of aneurysms occurring in young people make them unique in comparison to the adult counterpart, such as a predilection for male patients, location at the internal carotid bifurcation, and association with other diseases. Controversy remains as to whether relatively greater proportions of pediatric aneurysms are giant (>25 mm) or occur in the posterior circulation as compared with adult aneurysms. Discrepancies exist not only in the characterization of their features but also with respect to clinical outcome, with good results ranging from 40% to 92% [2], [3], [26], [27], [31], [48], [55]. This is caused by the fact that the case series in the literature include patients treated over the course of the previous half-century, with heterogeneous reporting of outcomes and length of follow-up.
We report the experience at our institution with 19 cases treated using contemporary microsurgical and endovascular techniques since 1991 and summarize all previously reported cases to more accurately describe this rare clinicopathological entity.
Section snippets
Patients and methods
Between 1991 and 2004, 19 (1.4%) of a total of 1377 cerebral aneurysm cases treated at the Johns Hopkins Hospital and the Johns Hopkins Bayview Medical Center occurred in patients aged 18 years or younger. Review of a prospectively accrued clinical database and hospital records was performed to identify and characterize these young patients with the diagnosis of intracranial aneurysm.
Radiographic studies, operative reports, and hospital records were retrospectively reviewed for each patient (
Patient characteristics
Nineteen intracranial aneurysms were treated in 19 patients (age range, 1 month to 18 years, mean 9.8 ± 5.7 years, Table 1). Only 3 patients were younger than 1 year, 8 were children between the ages of 5 and 12 years, and the remaining 8 patients were adolescents from 13 to 18 years old. Thirteen patients were boys, and 6 were girls, resulting in a male/female predominance of 2.2:1.
Presentation and associated medical conditions
Presentation with SAH occurred in 11 (58%) patients. According to clinical criteria defined by Hunt and Hess, 7
Historical perspective
The first definitive account of an intracranial aneurysm was published by Biumi of Milan in 1765 and later reprinted by Sandifort at Leyden in 1778. In this case, an ICA aneurysm was found at necropsy in a woman of advanced age who had severe rheumatic attacks. Many years later in his work entitled “Dropsy,” Blackhall reported a basilar tip aneurysm in a woman who developed sudden coma and death in 1814. In 1834, Nebel reported the first aneurysm series of 13 cases. This was followed by a
Conclusions
Intracranial aneurysms that occur in infancy, childhood, and adolescence are rare and account for less than 2% of all cerebral aneurysms. Compilation of the reports published since 1939 allows for the following conclusions: (1) major improvements in clinical outcomes have been achieved with contemporary microsurgical and endovascular techniques, (2) there is a male/female preponderance of 1.8:1, (3) SAH is the most common mode of presentation, (4) a quarter of all pediatric aneurysms occur at
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