Endovascular treatment of traumatic intracranial aneurysm in an infant. A case report

Abstract

Traumatic intracranial aneurysms in children are rare and mostly related to skull fracture or rapid decelerating closed head injury.We report the case of an infant who developed intracranial aneurysm after minor head trauma and managed by endovascular treatment. A seven-month-old infant presented with delayed intracranial hemorrhage following minor head trauma. Cerebral angiography disclosed a multilobulated fusiform aneurysm involving the right anterior cerebral artery (ACA) distal to the anterior communicating artery. Endovascular treatment of the aneurysm was performed and the infant made an excellent recovery during six months clinical and radiological follow-up. Delayed presentation of intracranial hemorrhage with acute deterioration in the infant after head trauma warrants angiography for proper diagnosis and management of the traumatic aneurysm, which has a high mortality rate after rupture and rebleeding. Endovascular treatment of traumatic aneurysm is feasible in infants, and occlusion of distal intracranial arterial aneurysms can be safely and precisely achieved using current coil technology.

Figure 1

A-B Brain CT showed a massive intraventricular hemorrhage with a parenchymal hemorrhage in the right subfrontal region (A) as well as some subarachnoid hemorrhage in the interhemispheric region (A and B).

Figure 2

A-B Surface shaded display of 3D reconstruction images (A and B) of right internal carotid angiography shows multilobulated dissecting aneurysm involving the proximal portion of A2 segment of right ACA including the origin of frontopolar artery.

Figure 3

A Selective angiography of right ACA using microcatheter shows close proximity of the origin of the artery of Heubner, and encroached origin of the frontopolar artery by the aneurysm. A) Control miocrocatheter angiography after placement of four fibered GDC coils shows total occlusion of the aneurysm with sacrificed ACA distal to the aneursym. There is a patent artery of Heubner proximal to the embolized aneurysm, and the anterior communicating artery is also patent with contrast opacification into the left ACA.

Figure 40

Right internal carotid angiogram shows nonvisualized right ACA and multiple segmental luminal narrowings at the right internal carotid artery, likely suggesting induced vasospasm (A). But prominent leptomeningeal collateral flow to the right frontal region is demonstrated through the right middle cerebral artery on delayed arterial phase (B).

Figure 5

Repeat right internal carotid angiogram at 6 months after embolization shows obliteration of the aneurysm as well as proximal right ACA (A). Prominent leptomeningeal collateral flow to the right frontal region is again demonstrated through the right middle cerebral artery on delayed arterial phase (B).