Delayed diagnosis of intracranial aneurysm in pediatrics: the risk of misdiagnosis-a case report

BACKGROUND

Aneurysms in the pediatric population are uncommon, requiring a high index of suspicion for diagnosis. We report a case of a child with head trauma and delayed diagnosed cerebral aneurysm.

METHODS

A 2-year-old girl was brought to the emergency room with seizures. Head imaging showed acute intraventricular hemorrhage, hydrocephalus, and paraclinoid aneurysm of the right internal carotid artery. She had been hospitalized elsewhere 1 month prior for traumatic brain injury after falling to the ground with subarachnoid and intraventricular hemorrhage and good recovery, but without diagnosis of aneurysm.

RESULTS

The child was treated with aneurysm embolization and ventriculoperitoneal shunt, being discharged asymptomatic.

CONCLUSION

Most primary intraventricular hemorrhage in pediatric population has identifiable etiology. A high rate of clinical suspicion, associated with a low threshold for vascular neuroimaging studies for children with spontaneous or atypical intracranial hemorrhage allow accurate diagnosis, appropriate treatment, and improved outcome.

Microanatomic Study of the Optic Canal

BACKGROUND

The continuous development of microsurgical techniques to treat lesions in and around the optic canal (OC) emphasizes the need for an accurate understanding of the microanatomy of the region.

METHODS

Forty anatomic specimens were studied, with emphasis on the OC. The sphenoid bone and related structures were decalcified, added to animal gelatin, cut into 1-mm thick slices, and observed through a surgical microscope. The OC was considered the course that contained exclusively the optic nerve (ON) and ophthalmic artery.

RESULTS

The mean distance between the medial walls of the OC was 12.2 mm, and the OC had an average length of 12.06 mm. The OC has a horizontal oval shape in the proximal (internal) segment; a round shape in the middle segment; and a vertical oval shape in the distal (external) segment at the orbital cavity. In the middle segment of the OC, the thickest wall of the OC was the lateral (average: 0.68 mm), while the medial, inferior, and superior wall measures had averages of 0.75, 0.40, and 0.39 mm, respectively. The lateral wall of the sphenoid sinus is located under the OC, and the inferior wall of the OC separates both structures. The ophthalmic artery inside the OC was always located under the ON, between the dural sheaths, and had an average diameter of 1.03 mm.

CONCLUSIONS

The neurovascular structures within the OC vary in size and shape. The anatomic knowledge of the OC and its variations allows better surgical results and minimizes the surgical morbidity.