Pediatric Intracranial Aneurysms: Endovascular Treatment

Background: Intracranial aneurysms are rare in pediatric age group. Their clinicoradiological features may differ from those in adults. Objective: The aim of this study was to analyze clinical presentation, location and morphological characteristics of pediatric age aneurysm with assessment of feasibility, safety and efficacy of endovascular treatment. Patients and Methods: A retrospective study was conducted on patients with intracranial aneurysm aged 18 years or younger who underwent endovascular treatment in the period between July 2006 and July 2014 in the Departments of Neurosurgery in Ain Shams University and Souhag University. Data were collected and analyzed as regard: presenting symptom, aneurysm characteristics (site, size and subtype), endovascular management, and procedure clinic-radiological outcome and follow up were analyzed. There were twenty-two patients with twenty-two aneurysms, age range 1.5 to 17 years with a mean of 10.97±4.69, 13 males and 9 females. Results: Subarachnoid hemorrhage was the main presentation with a rate of 54.4%, and the rate of associated underlying diseases was 40.9%. Saccular aneurysms (without clinical association of infection or trauma) were found in ten patients (45.5%), dissecting fusiform (without clinical association of infection or trauma) in seven patients (31.8%), infectious in three patients (13.6%) and traumatic in two patients (9.1%). Five aneurysms (22.7%) were located in the posterior circulation, while six were located at internal carotid artery (ICA) termination (27.3%). Five aneurysms (22.7%) were giant aneurysms. Endovascular coiling was done in thirteen aneurysms (59.1%): ten were saccular, two traumatic, and one dissecting fusiform. Parent vessel occlusion was done in nine aneurysms (40.1%), three were infectious (glue was used), and six were fusiform aneurysms (four by detachable balloons and two by coils). Immediate angiographic cure was seen in twenty aneurysms (90.9%) and remaining two aneurysms had small neck residual. Recanalization at one year follow up occurred in three aneurysms (13.6%), two of which needed further endovascular treatment. There was no rebleeds during the follow up period. The rate of permanent procedure related complication and favorable outcome were 4.55% and 90.9% respectively. Conclusion: Pediatric intracranial aneurysms are a rare entity with different characteristics than adult aneurysms. In pediatric aneurysms association of an underlying disease should be considered. The rate of giant, dissecting fusiform and mycotic aneurysms is more common then in adults. ICA bifurcation and posterior circulation located aneurysms have higher incidence in pediatric patients than adults do. Endovascular treatment with different techniques is considered technically feasible, relatively safe and efficient with high favorable outcome and low rates of mortality and morbidity, yet longer period of follow up is needed to assure long term safety.