Diagnosis and treatment of ruptured intracranial aneurysms in infants

Objective To investigate the epidemiological characteristics, clinical manifestations and treatment of intracranial aneurysms in infants. Methods From January 2010 to December 2016, 6 256 cases of intracranial aneurysms were consecutively admitted to Neurosurgery Department of West China Hospital of Sichuan University, 6 (0.1‰) of whom were less than 1 years old. Among them, the youngest was 2 months old and the oldest was 11 months old. We retrospectively analyzed medical records of the 6 patients with ruptured intracranial aneurysms. In those 6 cases, 5 patients were female, and 1 was male. The time of diagnosis in 6 cases was from 8 to 144 hours, and the primary symptom was vomiting in 4 cases. Convulsions were reported in 3 cases. All 6 cases had single aneurysms with mean diameter of 0.4-1.5 cm and included 1 with vertebrobasilar fusiform aneurysms (untreated) and 5 cases with cystic aneurysms from middle cerebral artery (MCA). Those 5 patients included 2 cases of pseudoaneurysms and all underwent craniotomy for aneurysm clipping. Results All aneurysms were successfully clipped in 5 cases with MCA aneurysms. None of them had complications such as cerebral vasospasm, cerebral infarction, hydrocephalus, intracranial infarction or cerebrospinal fluid leakage. The postoperative follow-up lasted for 7-68 months and no residual or recurrent aneurysm was found in CTA examination. Their intellectual development was normal and the muscle strength in the limbs recovered obviously in 5 patients, of which 1 was grade Ⅳ and 4 were grade Ⅴ. The Glasgow outcome scale was used to assess the outcome which revealed Ⅳ-Ⅴ in the 5 patients. Conclusions The incidence of infantile intracranial aneurysms is very low which mostly occurs in MCA. Due to lack of specific demonstrations, delayed diagnosis might be common for ruptured intracranial aneurysms in infants. In addition, infants with ruptured intracranial aneurysms might have good outcomes following surgical treatment. Key words: Intracranial aneurysm; Aneurysm, ruptured; Infant; Diagnosis; Microsurgery