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Yokoyama H, Nishihori M, Izumi T, Goto S, Kurimoto M, Kato M, Kanamori F, Uda K, Yokoyama K, Araki Y, Saito R. Ruptured Middle Cerebral Artery Aneurysm in an Infant: Case Report and Literature Review. NMC Case Rep J 2023; 10:177-183. [PMID: 37465251 PMCID: PMC10351959 DOI: 10.2176/jns-nmc.2022-0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/27/2023] [Indexed: 07/20/2023] Open
Abstract
Intracranial aneurysms (IA) in infants are reportedly rare at 0.5% to 4.5% of all aneurysms. Furthermore, subarachnoid hemorrhage in infants younger than three months are even rarer as it has been reported in approximately 20 cases only till date. A 3-month-old infant with seizures and impaired consciousness was admitted to our hospital. Three-dimensional computed tomography angiography (3D-CTA) revealed a dissecting aneurysm with a maximum diameter of 13 mm in the right M2. Internal trapping using detachable coil were successfully performed, following which he was discharged without significant neurological deficit after one month of onset. Thus, we have reported a rare case of a large ruptured dissecting IA in a 3-month-old infant, in the right middle cerebral artery (MCA), successfully treated with an endovascular therapy, along with a literature review.
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Affiliation(s)
- Hayato Yokoyama
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shunsaku Goto
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Michihiro Kurimoto
- Department of Neurosurgery, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Mihoko Kato
- Department of Neurosurgery, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Fumiaki Kanamori
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenji Uda
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
- Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Kinya Yokoyama
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
- Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Nagoya, Aichi, Japan
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Rubio Atienza Y, Ibiza Palacios E, del Peral Samaniego MP, Álvarez Montañana P, Molina Corbacho M, Modesto i Alapont V. Intraparenchymal brain hemorrhage due to rupture of aneurysm in infants: report of two cases. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2022. [DOI: 10.1186/s43054-022-00111-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cerebral or brain hemorrhage due to the rupture of intracranial aneurysms is extremely rare in pediatric population. The aim of our work is to describe two cases in children and to review the existent bibliography about this issue.
Case presentation
Both of our patients presented with nonspecific symptoms and subsequent neurological deficit. The brain imaging test revealed intraparenchymal hemorrhage. In both cases, the aneurysm was located at the distal portion of the middle cerebral artery. Surgical intervention was needed, clipping the aneurysm due to the impossibility of intravascular embolization. After the surgery, one patient presented with persistent hydrocephalus secondary to intraventricular hemorrhage, requiring the placement of a cerebrospinal fluid shunt. Over time, the child presented with refractory epilepsy compatible with West syndrome. The second patient did not present postoperative complications but died suddenly 2 months after.
Conclusions
Our two patients presented with a middle cerebral artery aneurysm at the distal level, which seems to be the most frequent location according to literature. The correct diagnosis can be delayed because of the nonspecific initial symptoms, as occurred in one of our patients with a delay of 3 days from the onset of symptoms. In both patients, surgical treatment was preferred over endovascular treatment, due to the anatomical characteristics of the aneurysm and the patient’s age.
Torpid evolution is also described, with one of our patients dying at 2 months, probably due to rebleeding, and the other suffering right hemiparesis and epilepsy compatible with West syndrome.
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Clarke JE, Luther E, Oppenhuizen B, Leuchter JD, Ragheb J, Niazi TN, Wang S. Intracranial aneurysms in the infant population: an institutional case series and individual participant data meta-analysis. J Neurosurg Pediatr 2022; 30:78-88. [PMID: 35426827 DOI: 10.3171/2022.2.peds21234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 02/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Infantile intracranial aneurysms are exceedingly rare. The goal of this study was to evaluate an institutional case series of infantile intracranial aneurysms, as well as those reported in the contemporary literature, to determine their demographics, presentation, management, and long-term outcome. METHODS A comprehensive literature review from 1980 to 2020 was performed to identify individual cases of intracranial aneurysms in the infantile population ≤ 2 years of age. Additional cases from the authors' institution were identified during the same time period. An individual participant data meta-analysis (IPDMA) was performed, abiding by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Patient demographic, radiographic, and clinical information was obtained. Descriptive statistical data were recorded, and multivariate logistic regression analyses were performed. RESULTS Patient data were obtained for 133 patients from 87 articles in the literature. Ten additional patients at the authors' institution were also identified, for a total of 143 patients included in the IPDMA. The majority (72.7%) of this cohort consisted of idiopathic aneurysms, while 13.3% were posttraumatic pseudoaneurysms, 9.8% were infectious mycotic aneurysms, and 4.2% were aneurysms associated with a systemic connective tissue disorder or vasculitis. The mean age at presentation was 6.6 months. The majority of infants (97.9%) harbored only 1 aneurysm, and hemorrhage was the most common presenting feature (78.3%). The mean aneurysm size was 14.4 mm, and giant aneurysms ≥ 25 mm comprised 12.9% of the cohort. Most aneurysms occurred in the anterior circulation (80.9%), with the middle cerebral artery (MCA) being the most commonly affected vessel (51.8%). Management strategies included open surgical aneurysm ligation (54.0%), endovascular treatment (35.0%), surgical decompression without aneurysm treatment (4.4%), and medical supportive management only (13.9%). Surgical aneurysm ligation was more commonly performed for MCA and anterior cerebral artery aneurysms (p = 0.004 and p = 0.015, respectively), while endovascular techniques were favored for basilar artery aneurysms (p = 0.042). The mean follow-up period was 29.9 months; 12.4% of the cohort died, and 67.0% had a favorable outcome (Glasgow Outcome Scale score of 5). CONCLUSIONS This study is, to the authors' knowledge, the largest analysis of infantile intracranial aneurysms to date. The majority were idiopathic aneurysms involving the anterior circulation. Surgical and endovascular techniques yielded equally favorable outcomes in this cohort. Long-term outcomes in the infantile population compared favorably to outcomes in adults.
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Affiliation(s)
| | - Evan Luther
- 1Leonard M. Miller School of Medicine and
- 2Department of Neurosurgery, University of Miami; and
| | | | | | - John Ragheb
- 2Department of Neurosurgery, University of Miami; and
- 3Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida
| | - Toba N Niazi
- 2Department of Neurosurgery, University of Miami; and
- 3Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida
| | - Shelly Wang
- 2Department of Neurosurgery, University of Miami; and
- 3Division of Neurosurgery, Brain Institute, Nicklaus Children's Hospital, Miami, Florida
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Aldea CC, Florian IA, Timiș TL, Andrașoni Z, Florian IS. Ruptured AComA aneurysm and asymptomatic bilateral ACA vasospasm in an infant: surgical case report. Childs Nerv Syst 2022; 38:633-641. [PMID: 34021372 DOI: 10.1007/s00381-021-05215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/13/2021] [Indexed: 11/27/2022]
Abstract
Intracranial aneurysms (IAs) are localized dilations of the cerebral vasculature, representing the leading cause for non-traumatic subarachnoid hemorrhage and an important source of morbidity and mortality. Despite it being a frequent pathology and most often diagnosed incidentally, IAs in infants are a very rare occurrence, and the ruptured variant is exceptional. A 4-month-old boy with a negative family history was brought to our department because of several episodes of incoercible vomiting and fever. Upon examination, the child was somnolent, without any noticeable deficit. Transfontanellar ultrasonography and CT angiography revealed a ruptured aneurysm of the anterior communicating artery (AComA), whereas the pre-clipping MRI showed thin, almost angiographically invisible anterior cerebral arteries (ACAs) on both sides due to vasospasm. We intervened surgically by placing an external ventricular shunt in an emergency setting, followed by clipping of the IA in a delayed manner. The child was discharged a month after admission with no deficit, despite the paradoxical aspect of the ACA. Ruptured IAs can be safely treated via microsurgery, even in infants. However, this requires a great amount of experience and surgical expertise. Furthermore, the lack of proper management would most likely result in a severe deficit in the long term. Lastly, the lack of visibility of the ACA on angiographic studies may not have neurological consequences if they occur in this age group.
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Affiliation(s)
| | - Ioan Alexandru Florian
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania. .,Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Teodora Larisa Timiș
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Zorinela Andrașoni
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania
| | - Ioan Stefan Florian
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania.,Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Garrido E, Metayer T, Borha A, Langlois O, Curey S, Papagiannaki C, Di Palma C, Emery E, Derrey S, Gaberel T, Gilard V. Intracranial aneurysms in pediatric population: a two-center audit. Childs Nerv Syst 2021; 37:2567-2575. [PMID: 33876302 DOI: 10.1007/s00381-021-05151-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Intracranial aneurysms (IA) in children are rare, accounting for less than 5% of all IA. Due to their scarcity, the epidemiology is poorly understood and differs from adults in term of clinical presentation, size, location, and origin. Consequently, the treatment strategies are specific and cannot be only based on data from adult series. The aim of our study was to report the characteristics, management, and outcomes of children treated for IA in two university hospitals located in Normandy (France) over the last 17 years and to perform a literature review of this rare pathology. METHODS This retrospective study included 18 consecutive children (< 18 years old) admitted with cerebral aneurysm treated in two neurosurgery departments in Normandy, from 2001 to 2018. Computerized tomography and cerebral angiography established the diagnosis. Both endovascular and surgical procedures were discussed in all cases. Data focused on clinical condition at admission, characteristics of the IA, choice of the treatment modalities, and complications. The outcome at follow-up is based on Glasgow outcomes scale (GOS) at 1 year. RESULTS During the study period, 18 children (mean age: 12.6 years; sex ratio male/female: 2.3) were admitted with 21 IA. Aneurysms had a mean size of 13.6 mm with 4 giant aneurysms and were mostly located in the anterior circulation (16/21). Clinical presentations at onset were sudden symptoms related to a subarachnoid hemorrhage in 13 patients, headaches in 4 patients with giant aneurysm, and asymptomatic in one patient. Among the 13 patients with ruptured IA, 6 presented in poor preoperative condition (Hunt and Hess Grade ≥ 4). Treatment modalities consisted in embolization in 9 patients and surgery in 9 patients including 2 by-pass surgeries in fusiform aneurysms. Complications were similar in the two groups, but two cases of recanalization were observed in the endovascular group. At 1 year of follow-up, 14 children were in good condition (GOS Score > 4) and one died. Three children presented associated IA treated by the same technique as initial aneurysm. CONCLUSIONS Pediatric aneurysm is a different pathology compared with adults, occurring more frequently in male population with a higher proportion of giant aneurysms and aneurysms located in the internal carotid bifurcation. The use of endovascular techniques has progressed in the last years, but surgery was proposed for half of our population.
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Affiliation(s)
- Elisabeth Garrido
- Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France.
| | - Thomas Metayer
- Department of Neurosurgery, Caen University Hospital, Caen, France.,PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Normandie Univ, UNICAEN, I INSERM, U1237, Cyceron, 14000, Caen, France
| | - Alin Borha
- Department of Neurosurgery, Caen University Hospital, Caen, France.,PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Normandie Univ, UNICAEN, I INSERM, U1237, Cyceron, 14000, Caen, France
| | - Olivier Langlois
- Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | - Sophie Curey
- Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | | | - Camille Di Palma
- Department of Neurosurgery, Caen University Hospital, Caen, France
| | - Evelyne Emery
- Department of Neurosurgery, Caen University Hospital, Caen, France.,PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Normandie Univ, UNICAEN, I INSERM, U1237, Cyceron, 14000, Caen, France
| | - Stéphane Derrey
- Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | - Thomas Gaberel
- Department of Neurosurgery, Caen University Hospital, Caen, France.,PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Normandie Univ, UNICAEN, I INSERM, U1237, Cyceron, 14000, Caen, France
| | - Vianney Gilard
- Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France.,Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Normandie Univ, UNIROUEN, INSERM U1245, Rouen, France
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Goia A, Garrido E, Lefebvre M, Langlois O, Derrey S, Papagiannaki C, Gilard V. Ruptured Intracranial Aneurysm in a Neonate: Case Report and Review of the Literature. World Neurosurg 2020; 140:219-223. [PMID: 32407915 DOI: 10.1016/j.wneu.2020.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Intracranial aneurysms (IAs) are exceptional in neonates accounting for less than 2% of all IAs occurring during the first decade of life. Little is known about this pathology in this specific population. Because of its scarcity and this specific age at onset, the treatment of IA in neonates is challenging. We describe a rare case of aneurysmal subarachnoid hemorrhage in a neonate and review the current literature. CASE DESCRIPTION A 21-day-old boy was admitted for hypotonia, vomiting, and seizures. Computed tomography scan revealed a subarachnoid hemorrhage in the sylvian fissure, a frontoparietal subdural hematoma, a left middle cerebral artery (MCA) aneurysm with a diameter of 11 mm, and an infarct of the MCA frontal region. He was successfully treated with endovascular coiling, neuroprotection, and antiepileptic drugs. Immediate postoperative magnetic resonance imaging showed a good aneurysm occlusion without any further ischemia. The outcome was favorable with extubation at day 10. At follow-up, the child experienced normal psychomotor development with no motor deficit. CONCLUSIONS Ruptured IAs in neonates are rare. Subarachnoid hemorrhage is the most common presentation. Intracranial aneurysms are frequently larger than 10 mm and located on the MCA. The treatment could be surgical or endovascular depending on the characteristics of the aneurysm. There is no recommendation concerning the prevention or treatment of vasospasm in neonates.
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Affiliation(s)
- Alice Goia
- Department of Neurosurgery, Rouen University Hospital, Rouen, France
| | - Elisabeth Garrido
- Department of Neurosurgery, Rouen University Hospital, Rouen, France
| | - Margaux Lefebvre
- Department of Interventional Neuroradiology, Rouen University Hospital, Rouen, France
| | - Olivier Langlois
- Department of Neurosurgery, Rouen University Hospital, Rouen, France
| | - Stéphane Derrey
- Department of Neurosurgery, Rouen University Hospital, Rouen, France
| | - Chrysanthi Papagiannaki
- Department of Interventional Neuroradiology, Rouen University Hospital, Rouen, France; University of Limoges CNRS XLIM UMR 7252, Limoges, France
| | - Vianney Gilard
- Department of Neurosurgery, Rouen University Hospital, Rouen, France; Department of Interventional Neuroradiology, Rouen University Hospital, Rouen, France; University of Limoges CNRS XLIM UMR 7252, Limoges, France; Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Normandie University, UNIROUEN, INSERM U1245, Rouen, France.
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