Clinical features and endovascular treatment of pediatric intracranial aneurysms

Objective To investigate the clinical features and endovascular treatment of pediatric intracranial aneurysms. Methods The clinical data of 35 consecutive children (≤18 years) with intracranial aneurysm (37 aneurysms) admitted to Intervention Center, Beijing Neurosurgical Institute, Capital Medical University and treated with endovascular treatment from January 2001 to December 2012 were analyzed retrospectively. The imaging characteristics, clinical characteristics, endovascular treatment modalities and immediate results of embolization in 35 children were analyzed and summarized. All 35 patients underwent endovascular treatment. Of the 37 aneurysms, 13 (35%) were treated with coil treatment alone, 8 (22%) were treated with stent assisted coil embolization, 3 (8%) were treated with stents alone, 1 (3%) was treated with balloon-assisted therapy, 6 (16%) were treated with parent artery occlusion alone, and 6 (16%) were treated with parent artery occlusion and coils. Results Of the 35 children, 30 (86%) were males, 5 (14%) were females (male∶female=6∶1); there were 15 (41%) anterior circulation aneurysms and 22 (59%) posterior circulation aneurysms (anterior circulation∶posterior circulation=1.00∶1.47); there were 15 (41%) large aneurysms (diameter 10-25 mm) and 7 (19%) giant aneurysms (diameter ≥25 mm). There were 29 (78%) complex aneurysms. Twelve patients had (34%) subarachnoid hemorrhage. Immediate postoperative angiography showed aneurysm embolization. Raymond classification showed that 24 aneurysms (65%) were grade I, 8 (22%) were grade Ⅱ, and 5 (13%) were grade Ⅲ. They were followed up for 3 to 32 months after surgery. Glasgow outcome scale (GOS) and imaging examination were used to evaluate prognosis.Thirty children were followed up with angiography after endovascular treatment and 4 (13%) relapsed. Thirty-two children were followed up by telephone. GOS assessment showed that the postoperative recovery was good in 20 children, 8 had moderate disability, 3 had severe disability, 1 was in a vegetative state, and no one was dead. Conclusions Pediatric intracranial aneurysms have male predominance. They often occur in complex aneurysms, such as posterior circulation, large and giant, traumtic, dissection, fusiform, and irregularly aneurysms. The effect of endovascular treatment and prognosis are good. Key words: Intracranial aneurysm; Child; Endovascular therapy; Prognosis