Characteristics and Treatment Outcome of Intracranial Aneurysms in Children and Adolescents

Abstract

Objective: Intracranial aneurysms are not common in young age patients. We sought to find the characteristics of the intracranial aneurysms in patients under 20 years of age.

Methods: We reviewed 23 consecutive patients ≤20 years of age treated for their intracranial aneurysms during the period from 1995 to 2017. From medical records and imaging studies, we gathered data on age, sex, presentation, associated medical condition, location and characteristics of aneurysms, treatment and clinical outcomes.

Results: The patients' ages ranged from 13 months to 20 years (median, 14 years). There were 16 males and seven females (male to female ratio, 2.3 : 1) with 31 aneurysms. Clinical presentations included sudden severe headache in 61%, followed by altered mentality in 17% and seizure in 17%. More than one-fourth patients had specific medical conditions related to the development of the cerebral aneurysms. The majority of aneurysms occurred in the anterior circulation (71%), and were saccular (71%). There were each three patients with false aneurysms (13%) and giant aneurysms (13%), and only one patient with multiple aneurysms (4%). We treated 22 patients : 21 aneurysms with the endovascular methods, three with open surgery, and one with combined treatment. Good functional outcome could be achieved in 86% during the follow-up period.

Conclusion: In this series, the young-age patients with intracranial aneurysms were characterized by male predominance, related specific medical conditions, low incidence of multiple aneurysms, high incidence of giant aneurysms and good functional outcome after treatment.

Keywords: Aneurysm; Etiology; Pediatrics; Risk factors; Treatment outcome.

Fig. 1.

Graph of sex distrubution according to the patents’ ages. M : male, F : female.

Fig. 2.

A 14-year-old boy (case 12) presented with aggravating headache and nausea. His headache began 5 years ago on the left temple area, with no neurological deficit. He had no other past medical history. His mother and maternal grandfather had history of malignant hyperthermia and ryanodine receptor type 1 (RyR1) gene mutation. A : Magnetic resonance imaging showed a thrombosed aneurysm on the distal internal carotid artery (C1 segment). B : Cerebral angiography demonstrated an aneurysm of 9.8 mm in diameter at the stenosed communicating segment of the left internal carotid artery. C : He underwent endosaccular coil embolization with stent assistance. D : Follow-up cerebral angiography at 10 months after treatment showed no evidence of recurrence.

Fig. 3.

A 18-year-old boy (case 16) presented with headache. A : Cerebral angiography showed a giant aneurysm of 35.4 mm in maximal diameter at internal cerebral artery bifurcation. B : An intra-operative photograph of external carotid artery to middle cerebral artery bypass using the saphenous vein. C : Endovascular trapping of internal cerebral artery was performed. D : Two weaks later, rebleeding was found. E : Additional endovascular trapping was performed. In addition, surgical clipping and intracerebral hematoma evacuation were performed (not shown). F and G : Five-year follow-up cerebral angiography (F) and 7-year follow-up magnetic resonance angiography (G) showed patent bypass flow.

Fig. 4.

A graph of functional outcome according to rupture status of aneurysms at the times of admission and discharge and at the last outpatient check-up. mRS : modified Rankin scale.