Pediatric cerebral aneurysms: a report of 9 cases

Background. Intracranial aneurysms are rare in children, constituting less than 2% of all cerebral aneurysms. Relative to their adult Counterparts, published series are few and case numbers are small. Method. Nine children (5 males and 4 females, ages 13-18 years old) are reported. These patients constituted 6% of a total of 150 cerebral aneurysm cases treated at our institution over a 12-year period. Findings. Eight patients presented with subarachnoid haemorrhage; one patient's aneurysm was identified incidentally after head trauma. All but one of the patients were in good clinical grade (Hunt and Hess grades I to III). Aneurysm locations were: internal carotid artery (ICA) (5 cases), anterior communicating artery (2 cases), anterior cerebral artery (1 case) and vertebrobasilar junction (1 case). A giant (ICA bifurcation) aneurysm and bilateral ICA bifurcation aneurysms were each observed in one patient. Angiographic vasospasm was detected in three patients. Clinical deterioration attributable to vasospasm was observed in one of them. Seven patients underwent craniotomy, and aneurysms were clipped succesfully. One patient underwent endovascular coiling for a vertebrobasilar junction aneurysm. One patient died due to rebleeding before surgery on the second day of her initial haemorrhage. The 6-month Glasgow Outcome Score was 5 in seven patients and 4 in one patient. Conclusions. Our treatment regimen for pediatric aneurysms is similar to that used in adults, and consists of surgical clipping as the mainstay of treatment, with endovascular techniques reserved for selected cases. With the exception of one patient who died due to early rebleeding, this regimen resulted in good clinical outcomes.