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de Aguiar GB, Ozanne A, Elawady A, Samoyeau T, Niknejad HR, Caroff J, Vergara Martinez J, Mihalea C, Gallas S, Chalumeau V, Ikka L, Moret J, Spelle L. Intracranial Aneurysm in Pediatric Population: A Single-Center Experience. Pediatr Neurosurg 2022; 57:270-278. [PMID: 35398842 DOI: 10.1159/000524523] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 04/06/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Pediatric intracranial aneurysms (PIA) are rarer and more complex when compared to adult aneurysms. In general, the clinical presentation of PIA is due to a mass effect, but the presenting symptoms can be also related to ischemia, subarachnoid hemorrhage (SAH), or in a combination of different symptoms. This paper aimed to report a single-center experience with clinical and angiographic aspects of brain aneurysm in children. METHODS We retrospectively reviewed our prospectively maintained database for patients with intracranial aneurysms in our institution from July 2015 to February 2021. Among these, all patients under 18 years of age submitted to a diagnostic or therapeutic procedure for an intracranial aneurysm were included. RESULTS Twelve patients were submitted to diagnostic or therapeutic procedures in our department. Three of them had multiple aneurysms, and in total, 17 intracranial aneurysms were assessed in this study. The most frequent location was in the middle cerebral artery (7 cases/41%). Five out of twelve children (42%) presented SAH due to ruptured aneurysm. Three patients (25%) had symptoms due to the mass effect from large aneurysms, with compression of cranial nerves or brainstem. Aneurysms diameters ranged from 1.5 mm to 34 mm (mean 14.2 mm), with six aneurysms being giant and eight being nonsaccular/fusiform. Twelve aneurysms were submitted to endovascular treatment, with one treatment-related clinical complication and later death. CONCLUSION PIAs are rare diseases that can arise from a variety of different underlying pathological mechanisms. The management of these conditions requires a detailed understanding of the pathology and a multidisciplinary approach. Despite the availability of new technologies, parent vessel occlusion remains a valid option for aneurysms in the pediatric population.
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Affiliation(s)
- Guilherme Brasileiro de Aguiar
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Augustin Ozanne
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Ahmed Elawady
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Thomas Samoyeau
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Hamid Reza Niknejad
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France,
| | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Jeickson Vergara Martinez
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Cristian Mihalea
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Sophie Gallas
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Vanessa Chalumeau
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Léon Ikka
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Jacques Moret
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France
| | - Laurent Spelle
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, Le Kremlin-Bicêtre, France.,Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicêtre, France
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Songsaeng D, Srivatanakul K, Krings T, Geibprasert S, Ozanne A, Lasjaunias P. Symptomatic spontaneous vertebrobasilar dissections in children: review of 29 consecutive cases. J Neurosurg Pediatr 2010; 6:233-43. [PMID: 20809707 DOI: 10.3171/2010.6.peds09290] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The purpose of this study is to analyze the clinical presentation, morphological characteristics, angio-architecture, and outcome of vertebrobasilar dissection (VBD) in the pediatric population. METHODS The authors retrospectively reviewed 29 consecutive cases involving children younger than 16 years of age who were diagnosed with symptomatic VBDs. Data were gathered with respect to the patient's age, sex, clinical history, associated underlying disease, and symptoms (headache, vertigo) as well as the location of the dissection and the imaging appearance. RESULTS The patients' mean age was 8.24 years (range 2 months-15 years). There was an overall 3:1 male predominance, although among children older than 8 years, girls and boys were similarly affected. Hemorrhagic dissections occurred in 10 of 29 cases. In nonhemorrhagic dissections, stroke occurred in 16 cases, with the most common presenting symptoms being headaches and vertigo; in the other 3 cases, mass effect due to a chronic dissecting aneurysm was present. In 7 children an underlying vessel wall disease was found. The location of the dissection was extradural in 11 cases and intradural in the remainder. There was no preference with respect to side. The basilar artery was affected in 9 patients. CONCLUSIONS The imaging appearance and clinical presentation of symptomatic VBDs in the pediatric population differs from that in adults. Boys are more often affected, especially at younger ages, and hemorrhagic presentation is more common, presumably owing to the fact that the basilar artery is more commonly involved. Depending on the pathogenetic mechanism underlying the dissection, different clinical symptoms will evolve, necessitating individually tailored treatment.
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Affiliation(s)
- Dittapong Songsaeng
- Service de Neuroradiologie Diagnostique Thérapeutique, Hôpital de Bicêtre-Université Paris-sud Orsay, Le Kremlin-Bicêtre, France
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Sun T, Zhao J. Multiple saccular aneurysms of the extracranial and intracranial internal carotid artery associated with convexobasia and arachnoid cyst in a 6-year-old boy: a case report. Childs Nerv Syst 2010; 26:113-6. [PMID: 19763589 DOI: 10.1007/s00381-009-0986-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We report an extremely rare case of multiple saccular aneurysms of the extracranial and intracranial internal carotid artery associated with convexobasia of the left temporal region and arachnoid cyst in a 6-year-old boy. CASE REPORT A 6-year-old male patient was admitted to the hospital with chief complaint of ptosis and engorgement of the left eyelid for 50 days. A 4 x 10-cm bony protuberance of the left temporal region with hemangiectasia was observed to beat with pulse without vascular murmur. computed tomographic angiography (CTA) showed two saccular aneurysms of the left internal carotid artery. The first one which was about 3 cm in length and 2 cm in maximum diameter was located in the middle of the petrous portion (including parts of C2 and C3). The second one which was about the same size was located from the middle of the cavernous portion to the upper end of the left internal carotid artery. Computed tomography showed an arachnoid cyst in the left temporal region and abnormality of the left temporal bone. According to the specific circumstances of this patient, we believe that surgical treatment is rather risky and the loss might outweigh the gain. Therefore, we suggested to the parents that the child should be followed up for the coming years for monitoring and possible treatment. DISCUSSION Multiple saccular aneurysms of extracranial and intracranial internal carotid artery in children are extremely rare. According to this case, the child had congenital bony protuberance of the left temporal region with hemangiectasia, which made this case particularly specific. Besides all those discovered abnormalities, this child was a healthy boy. Due to the difficulty and high risk of possible surgical treatment, we suggested that no further treatment be performed at the moment and the child should be followed up for a long period of time. Worthy examinations such as CT, CTA, and MRI are recommended for reviewing the development of aneurysms and CNS of this boy. Further treatment might be performed in the future. We welcome all forms of discussion about this case and similar cases around the globe.
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Affiliation(s)
- Taiji Sun
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Chongwen District, Beijing, 100050, China
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De Blasi R, Medicamento N, Chiumarullo L, Salvati A, Maghenzani M, Dicuonzo F, Carella A. A case of aneurysm on a persistent hypoglossal artery treated by endovascular coiling. Interv Neuroradiol 2009; 15:175-8. [PMID: 20465895 DOI: 10.1177/159101990901500206] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Accepted: 04/05/2009] [Indexed: 11/16/2022] Open
Abstract
SUMMARY We describe a 22-year-old woman admitted to hospital in emergency with nuchal headache and vomiting. CT scan disclosed subarachnoid hemorrhage. Digital subtraction angiography with three-dimensional rotational acquisitions showed a ruptured aneurysm of a right persistent primitive hypoglossal artery as the cause of symptoms and hemorrhage. The patient was successfully treated with endovascular coiling of the aneurysm. This is the second literature report describing endovascular treatment in this unusual condition.
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Affiliation(s)
- R De Blasi
- Department of Neuroradiology, Bari University Hospital; Bari, Italy -
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