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Hokari M, Shimbo D, Uchida K, Asaoka K, Ajiki M, Itamoto K, Takada T. Two illustrative cases of traumatic intracranial cerebral artery dissection in children. Radiol Case Rep 2024; 19:5088-5093. [PMID: 39263524 PMCID: PMC11387544 DOI: 10.1016/j.radcr.2024.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 09/13/2024] Open
Abstract
Traumatic intracranial cerebral artery dissection (ICAD) in the pediatric population is relatively rare. We report two traumatic ICAD cases in children. Case 1: A 13-year-old boy presented with headache and left hemiparesis after body contact while playing basketball. We found a cerebral infarction in the middle cerebral artery territory and dissection at the bifurcation of the right internal carotid artery and posterior communicating artery. Six days after onset, his right hemiparesis deteriorated, and the infarction progressed. Therefore, bypass surgery was performed. Three months later, he regained the ability to walk without a cane and resumed school. Case 2: A 10-year-old boy fell while skiing and experienced a severe headache several hours later. Neuroradiological examination revealed a subarachnoid hemorrhage in the basal cistern without aneurysm. Six days after admission, magnetic resonance angiography revealed stenotic changes and an irregularly shaped basilar artery (BA). On day 7, an angiogram confirmed BA dissection. The patient's headache gradually improved, and the irregular shape of the BA normalized 3 weeks later. He was discharged without any neurological deficits. Determining whether vascular reconstruction should be performed is challenging. However, we believe that therapeutic intervention should be performed promptly when symptoms or brain images deteriorate.
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Affiliation(s)
- Masaaki Hokari
- Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Japan
| | - Daisuke Shimbo
- Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Japan
| | - Kazuki Uchida
- Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Japan
| | - Katsuyuki Asaoka
- Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Japan
| | - Minoru Ajiki
- Department of Cerebrovascular Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Koji Itamoto
- Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tatsuro Takada
- Department of Cerebrovascular Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
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2
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Lefevre E, Fawaz R, Premat K, Lenck S, Shotar E, Degos V, Kalamarides M, Boch AL, Carpentier A, Clarençon F, Nouet A. Delayed traumatic intracranial aneurysms: literature review and case series. Neurosurg Rev 2024; 47:355. [PMID: 39060452 DOI: 10.1007/s10143-024-02586-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/16/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
Traumatic intracranial aneurysm (TICA) is a rare and aggressive pathology that requires prompt treatment. Nevertheless, early vascular imaging following head trauma may yield falsely negative results, underscoring the importance of subsequent imaging within the first week to detect delayed TICAs. This study aims to report our experience with delayed TICAs and highlight the clinical importance of repeated angiographic screening for delayed TICAs. In this retrospective analysis, we evaluated patients managed for a TICA at a tertiary care teaching institution over the last decade. Additionally, we conducted a systematic review of the literature, following the PRISMA guidelines, on previously reported TICAs, focusing on the time lag between the injury and diagnosis. Twelve delayed TICAs were diagnosed in 9 patients. The median time interval from injury to diagnosis was 2 days (IQR: 1-22 days), and from diagnosis to treatment was 2 days (IQR: 0-9 days). The average duration of radiological follow-up was 28 ± 38 months. At the final follow-up, four patients exhibited favorable neurological outcomes, while the remainder had adverse outcomes. The mortality rate was 22%. Literature reviews identified 112 patients with 114 TICAs, showcasing a median diagnostic delay post-injury of 15 days (IQR: 6-44 days), with 73% diagnosed beyond the first week post-injury. The median time until aneurysm rupture was 9 days (IQR: 3-24 days). Our findings demonstrate acceptable outcomes following TICA treatment and highlight the vital role of repeated vascular imaging after an initial negative computed tomography or digital subtraction angiography in excluding delayed TICAs.
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Affiliation(s)
- Etienne Lefevre
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de l'hôpital, Paris, 75013, France.
- Sorbonne University, Paris, France.
| | - Rayan Fawaz
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de l'hôpital, Paris, 75013, France
| | - Kevin Premat
- Sorbonne University, Paris, France
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Stéphanie Lenck
- Sorbonne University, Paris, France
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne Université, INSERM, Institut de la vision, Paris, France
| | - Vincent Degos
- Sorbonne University, Paris, France
- Department of Anesthesia and Intensive Care, Sorbonne University, Pitié- Salpêtrière Hospital, APHP, DMU DREAM, GRC 29, Paris, France
| | - Michel Kalamarides
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de l'hôpital, Paris, 75013, France
- Sorbonne University, Paris, France
| | - Anne-Laure Boch
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de l'hôpital, Paris, 75013, France
- Sorbonne University, Paris, France
| | - Alexandre Carpentier
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de l'hôpital, Paris, 75013, France
- Sorbonne University, Paris, France
| | - Frédéric Clarençon
- Sorbonne University, Paris, France
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Aurélien Nouet
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de l'hôpital, Paris, 75013, France
- Sorbonne University, Paris, France
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3
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Kommareddy A, Varma A, Vagha K, Javvaji CK, Vagha JD, Manchineni SB, Reddy NS. Successful Surgical Management of a Ruptured Intracranial Aneurysm in a Nine-Month-Old Male: A Rare Pediatric Case. Cureus 2024; 16:e63684. [PMID: 39092360 PMCID: PMC11293608 DOI: 10.7759/cureus.63684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 07/02/2024] [Indexed: 08/04/2024] Open
Abstract
Intracranial aneurysms in pediatric populations are rare, with a distinct clinical profile compared to adult cases. This case report describes the clinical presentation, diagnosis, and treatment of a nine-month-old male with an intracranial aneurysm. The child presented with convulsions, a depressed sensorium, and subsequent neurological deficits. Initial imaging revealed subarachnoid hemorrhage, and further angiographic studies identified an aneurysm rupture from the parietal branch of the right middle cerebral artery. The patient underwent successful neurosurgical intervention, including right craniotomy and aneurysm clipping. Post-operative recovery was marked by gradual neurological improvement and the absence of further seizures. This case underscores the importance of prompt diagnostic imaging and surgical management in pediatric intracranial aneurysms, contributing to favorable outcomes despite the rarity of the condition in this age group.
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Affiliation(s)
- Anirudh Kommareddy
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashish Varma
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Keta Vagha
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Chaitanya Kumar Javvaji
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jayant D Vagha
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sai Bhavani Manchineni
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Naramreddy Sudheesh Reddy
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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4
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Hosseini EM, Zafarshamspour S, Ghasemi-Rad M, Benndorf G, Rasekhi A, Rafieossadat R. Endoluminal flow diversion as a primary treatment strategy for pediatric traumatic intracranial aneurysms: a case-based review of literature. Childs Nerv Syst 2024; 40:345-357. [PMID: 37750891 DOI: 10.1007/s00381-023-06161-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Traumatic intracranial aneurysms (TICAs) constitute a notable portion of pediatric intracranial aneurysms. Their unstable structure dictates a high incidence of rupture or mass effect from enlarging unruptured aneurysms, necessitating prompt diagnosis and treatment. TICAs often lack a true neck or are wide-necked, making them unsuitable for coil embolization and surgical clipping, and their fragile nature poses a risk of rupture during surgical and intrasaccular interventions. Endoluminal flow diverters (FD), deployed without requiring direct access to the aneurysmal sac, have emerged as an appealing sole treatment modality for TICAs. However, the clinical experience with this technique remains limited in the pediatric population. METHOD We describe the successful treatment of a paraclinoid TICA in a 4-year-old female using an endoluminal FD alone. Additionally, we conducted a literature review to assess the safety and effectiveness of this treatment modality in pediatric TICAs. RESULTS Endoluminal flow diversion led to complete aneurysm obliteration in our case, with no observed complication, at the 9-month follow-up. Our review of the previously reported pediatric TICAs managed by standalone flow diversion highlights this technique as safe, efficient, and promising as a sole treatment modality, particularly in the anterior circulation, with a high rate of persistent total obliteration and a low rate of complications. However, the requirement for long-term antiplatelet therapy with the possibility of frequent dose monitoring and adjustments warrants special attention when using endoluminal FDs. Until guidelines specifically addressing optimal antiplatelet therapy in children with intracranial FDs are formulated, adherence to existing protocols is imperative to avoid in-stent thrombosis. CONCLUSION Our literature review and personal experience indicate that endoluminal flow diversion can be a viable treatment approach for pediatric TICAs. However, prospective studies with extensive follow-ups are required to assess the durability of endoluminal FDs in treating pediatric TICAs, considering the long life expectancy of this demographic.
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Affiliation(s)
| | - Saber Zafarshamspour
- Department of Surgery, Rafsanjan University of Medical Sciences, Rafsanjan, Kerman, Iran
| | - Mohammad Ghasemi-Rad
- Department of Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Goetz Benndorf
- Department of Radiology, University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Alireza Rasekhi
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Rafieossadat
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
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5
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Pinto Silva R, Teles Silva C, Silva MJ, Alberto Silva P, Ribeiro A. Ruptured Intracranial Aneurysm in a 60-Day-Old Infant: An Extreme Case. Cureus 2024; 16:e53442. [PMID: 38435220 PMCID: PMC10909312 DOI: 10.7759/cureus.53442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/05/2024] Open
Abstract
The prevalence of aneurysms in children is low when compared to adults, being even rarer in the first year of life. They can be secondary to infections, traumatic brain injury, autoimmune diseases, or connective tissue diseases. Dissecting etiology is rare. A 60-day-old female infant, previously healthy, presented to the emergency department (ED) with irritability and loss of appetite since the preceding day, a fever of one-hour duration, and vomiting. Laboratory analysis revealed a hemoglobin level of 6.5 g/dL, without elevation of inflammatory markers. In the ED, she experienced two episodes, with a one-hour interval, of clonic movements of the upper eyelid and right upper limb, along with conjugate gaze deviation to the same side, which resolved after intravenous diazepam. Levetiracetam was initiated after the second episode. The anterior fontanelle became progressively tense. Brain computed tomography (CT) showed a voluminous intraparenchymal and subarachnoid hemorrhage with an aneurysm at the bifurcation of the left middle cerebral artery (MCA). Initially, an endovascular approach was tried but was not successful due to technical problems. Consequently, a Vaso-CT scan was performed that confirmed a dissecting aneurysm/pseudoaneurysm (8 mm × 10 mm × 10 mm) of the left MCA, originating from the upper wall of the M1 segment. Next, she underwent microsurgical exclusion of the aneurysm using microclips. Post-surgery brain CT showed acute ischemia in the entire MCA region. Follow-up angiography showed complete exclusion of the aneurysm. She evolved to grade 3 monoparesis of the upper limb at the six-month interval follow-up, which has been gradually improving with physical rehabilitation. The next-generation sequencing (NGS) panel for aneurysms and arterial dissections did not detect any pathogenic variants. Clinical presentation of cerebral aneurysms in infants can be subtle, and a high index of suspicion is required in cases of irritability, altered consciousness, seizures, bulging fontanelle, and motor deficits. Early detection is of utmost importance as it is associated with moderate mortality. Surgical treatment with the use of clips proved to be effective in this case.
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Affiliation(s)
| | - Cláudia Teles Silva
- Pediatric Intensive Care Unit, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Marta João Silva
- Pediatric Intensive Care Unit, Centro Hospitalar Universitário de São João, Porto, PRT
| | | | - Augusto Ribeiro
- Pediatric Intensive Care Unit, Centro Hospitalar Universitário de São João, Porto, PRT
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6
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Policicchio D, Boccaletti R, Aiello G. Letter to the editor regarding the article 'traumatic iatrogenic dissecting anterior cerebral artery aneurysms: conservative management as a therapeutic option'. Br J Neurosurg 2023; 37:1944-1945. [PMID: 33688767 DOI: 10.1080/02688697.2021.1896678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Domenico Policicchio
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | - Riccardo Boccaletti
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | - Giovanni Aiello
- Faculty of Medicine and Surgery, University of Sassari, Sassari, Italy
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7
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Chen K, Shi Y, Bao K, Huang C. Pediatric intracranial aneurysms: Endovascular treatment. Asian J Surg 2023; 46:5112-5113. [PMID: 37422393 DOI: 10.1016/j.asjsur.2023.06.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 07/10/2023] Open
Affiliation(s)
- Kai Chen
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, No.25 of Taiping Street, Luzhou, 646000, Sichuan, China
| | - Yu Shi
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, No.25 of Taiping Street, Luzhou, 646000, Sichuan, China
| | - Kunyang Bao
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, No.25 of Taiping Street, Luzhou, 646000, Sichuan, China
| | - Changren Huang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, No.25 of Taiping Street, Luzhou, 646000, Sichuan, China; Neurosurgical Clinical Research Center of Sichuan Province, Luzhou, China; Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China; Laboratory of Neurological Diseases and Brain Functions, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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8
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Fry L, Brake A, Heskett CA, LeBeau G, De Stefano FA, Alkiswani AR, Lei C, Le K, Peterson J, Ebersole K. Endovascular Management of Pediatric Traumatic Intracranial Pseudoaneurysms: A Systematic Review and Case Series. World Neurosurg 2023; 176:213-226. [PMID: 37059359 DOI: 10.1016/j.wneu.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE This study aims to systematically review the management and outcomes of pediatric patients who develop intracranial pseudoaneurysm (IPA) following head trauma or iatrogenic injury. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic literature review was performed. Additionally, a retrospective analysis was conducted on pediatric patients who underwent evaluation and endovascular treatment for IPA originating from head trauma or iatrogenic injury at a single institution. RESULTS Two hundred twenty-one articles in the original literature search. Fifty-one met inclusion criteria resulting in a total of 87 patients with 88 IPAs including our institution. Patients ranged in age from 0.5 months to 18 years. Parent vessel reconstruction was used as first-line treatment in 43 cases, parent vessel occlusion in 26, and direct aneurysm embolization (DAE) in 19. Intraoperative complications were observed in 3.00% of procedures. Complete aneurysm occlusion was achieved in 89.61% of cases. 85.54% of cases resulted in favorable clinical outcomes. The mortality rate after treatment was 3.61%. The DAE group had higher rates of aneurysm recurrence than other treatment strategies (P = 0.009). Patients with SAH had overall worse outcomes compared to patients who did not (P = 0.024). There were no differences in favorable clinical outcomes (P = 0.274) or complete aneurysm occlusion (P = 0.13) between primary treatment strategies. CONCLUSIONS IPAs were successfully obliterated, and favorable neurological outcomes were achieved at a high rate regardless of primary treatment strategy. DAE had a higher rate of recurrence than the other treatment groups. Each described treatment method in our review is safe and viable for the treatment of IPAs in pediatric patients.
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Affiliation(s)
- Lane Fry
- The University of Kansas School of Medicine, Kansas City, Kansas
| | - Aaron Brake
- The University of Kansas School of Medicine, Kansas City, Kansas
| | - Cody A Heskett
- The University of Kansas School of Medicine, Kansas City, Kansas.
| | - Gabriel LeBeau
- The University of Kansas School of Medicine, Kansas City, Kansas
| | - Frank A De Stefano
- Department of Neurological Surgery, University of Kansas Health System, Kansas City, Kansas
| | | | - Catherine Lei
- The University of Kansas School of Medicine, Kansas City, Kansas
| | - Kevin Le
- The University of Kansas School of Medicine, Kansas City, Kansas
| | - Jeremy Peterson
- Department of Neurological Surgery, University of Kansas Health System, Kansas City, Kansas
| | - Koji Ebersole
- Department of Neurological Surgery, University of Kansas Health System, Kansas City, Kansas
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9
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Han JW, Lee JI, Hwangbo L. [Endovascular Treatment for Head and Neck Trauma]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:792-808. [PMID: 37559799 PMCID: PMC10407061 DOI: 10.3348/jksr.2023.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/09/2023] [Accepted: 07/08/2023] [Indexed: 08/11/2023]
Abstract
Trauma to the head and neck region can have serious consequences for vital organs such as the brain, and injuries to blood vessels can cause permanent neurological damage or even death. Thus, prompt treatment of head and neck vessels is crucial. Although the level of evidence is moderate, an increasing amount of research indicates that endovascular treatments can be a viable alternative to traditional surgery or medical management. Embolization or reconstructive endovascular procedures can significantly improve patient outcomes. This article provides an overview of various endovascular options available for specific clinical scenarios, along with examples of cases in which they were employed.
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10
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Takeda K, Oda K, Fukumoto H, Kobayashi H, Morishita T, Takemoto K, Iwaasa M, Abe H. Repeated coil embolization of traumatic basilar artery pseudoaneurysm accompanied by bilateral traumatic internal carotid artery stenosis following severe head injury in a pediatric patient: A case report and literature review. Surg Neurol Int 2023; 14:199. [PMID: 37404524 PMCID: PMC10316180 DOI: 10.25259/sni_267_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/26/2023] [Indexed: 07/06/2023] Open
Abstract
Background Few cases of pediatric traumatic intracranial aneurysms (pTICAs) in the posterior circulation involving the basilar artery (BA) following severe head trauma have been reported. Here, we describe a pediatric case of traumatic BA pseudoaneurysm accompanied by bilateral traumatic internal carotid artery (ICA) stenosis following blunt head trauma. Case Description A 16-year-old boy presented to our emergency department after being hit by a car. The patient was initially diagnosed with multiple skull base fractures underlying traumatic subarachnoid hemorrhage and left acute epidural hematoma. Seven days following emergency craniectomy, magnetic resonance imaging revealed bilateral ICA stenosis, BA stenosis, and BA pseudoaneurysm. We decided to perform coil embolization, resulting in body filling and a volume embolization ratio of 15.7%. Twenty-eight days after coil embolization, digital subtraction angiography revealed aneurysmal rupture. We performed repeated coil embolization, resulting in body filling and a volume embolization ratio of 20.9%. Conclusion We reported a pediatric case of traumatic BA pseudoaneurysm accompanied by bilateral traumatic ICA stenosis following a severe head injury treated with repeated coil embolization. Considering the risk of further brain injury due to high incidence of rupture, early vascular survey and appropriate treatment may be the most important prognostic factors in pTICAs.
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Affiliation(s)
| | - Kazunori Oda
- Corresponding author: Kazunori Oda, Department of Neurosurgery, Fukuoka University, Fukuoka, Japan.
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11
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Krůpa P, Krajina A, Lojík M, Adamkov J, Česák T. Flow Preserving Endovascular Treatment of Traumatic Pseudoaneurysms of the Distal Anterior Cerebral Artery-Case Reports and Review of Literature. Brain Sci 2022; 12:634. [PMID: 35625019 PMCID: PMC9139790 DOI: 10.3390/brainsci12050634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 12/05/2022] Open
Abstract
Traumatic intracranial pseudoaneurysms (tIPAs) are a very rare pathology caused by blunt or penetrating head trauma. Diagnostic and therapeutic challenges of tIPAs are due to their unpredictable onset during the initial injury, or in a delayed manner, their unclear traumatic mechanism. Moreover, the presence of subarachnoid, subdural, or intraventricular hematoma may often cause them to be overlooked, which can potentially be followed by lethal rebleeding. Treatment of these lesions is controversial and on a case-by-case basis with regard to endovascular therapy or open surgery. We report two cases of three tIPAs of the distal anterior cerebral artery (dACA) with immediate and delayed onset after the trauma. Endovascular therapy resulted in complete obliteration of lesions with flow preservation in the parent artery using the flow diverter-assisted coiling strategy. The aim of this manuscript is to discuss the mechanism, angioanatomical characteristics, and current treatment options for these exceptional lesions.
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Affiliation(s)
- Petr Krůpa
- Department of Neurosurgery, Faculty Hospital, Faculty of Medicine in Hradec Kralove, Charles University, 50346 Hradec Kralove, Czech Republic; (J.A.); (T.Č.)
- Department of Neuroregeneration, Institute of Experimental Medicine, Czech Academy of Sciences, 14220 Prague, Czech Republic
| | - Antonín Krajina
- Department of Radiology, Faculty Hospital, Faculty of Medicine in Hradec Kralove, Charles University, 50346 Hradec Kralove, Czech Republic; (A.K.); (M.L.)
| | - Miroslav Lojík
- Department of Radiology, Faculty Hospital, Faculty of Medicine in Hradec Kralove, Charles University, 50346 Hradec Kralove, Czech Republic; (A.K.); (M.L.)
| | - Jaroslav Adamkov
- Department of Neurosurgery, Faculty Hospital, Faculty of Medicine in Hradec Kralove, Charles University, 50346 Hradec Kralove, Czech Republic; (J.A.); (T.Č.)
| | - Tomas Česák
- Department of Neurosurgery, Faculty Hospital, Faculty of Medicine in Hradec Kralove, Charles University, 50346 Hradec Kralove, Czech Republic; (J.A.); (T.Č.)
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12
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Yeap MC, Chung MW, Chen CT. Traumatic aneurysm at the superior cerebellar artery: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21577. [PMID: 35855486 PMCID: PMC9281434 DOI: 10.3171/case21577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Traumatic aneurysms at the superior cerebellar arteries after head injury are extremely rare and may be overlooked. Rupture of these aneurysms can cause fatal intracranial hemorrhages; thus, early identification of the entity helps prevent detrimental outcomes. OBSERVATIONS A patient suffered from sudden severe headache and decreased consciousness level several weeks after a blunt head injury. He received surgery to remove a progressive enlarging subdural hematoma. The diagnosis of a traumatic aneurysm at the superior cerebellar artery was delayed, made only after a recurrent subdural hemorrhage occurred. He received another surgery to obliterate the aneurysm. LESSONS The patient could have been treated earlier if traumatic aneurysm had been suspected in the beginning. In addition to the case, the authors also reviewed the literature to clarify the pathophysiology, clinical presentation, diagnosis, and management of the disease.
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Affiliation(s)
| | - Meng-Wu Chung
- General Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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13
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Palmieri M, Pesce A, Zancana G, Armocida D, Maiese A, Cirelli C, Santoro A, Frati P, Fineschi V, Frati A. Post-traumatic intracranial pseudo-aneurysms of posterior circulation: a comprehensive review of an under-diagnosed and rare entity. Neurosurg Rev 2021; 45:1019-1029. [PMID: 34608549 PMCID: PMC8976800 DOI: 10.1007/s10143-021-01657-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/08/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022]
Abstract
Traumatic aneurysms are rare and the total number of cases involving the posterior circulation (TIPC) is even smaller. Traumatic brain injury (TBI) may be responsible not only of rupture in brain aneurysm (BrA) pre-existing to trauma, but it has been identified also as a possible pathogenetic cause of TIPC formation in patients not affected by intracranial vascular lesions. A complete literature review was performed of all reported cases regarding rupture of BrA with SAH resulting from TIPC not previously identified at the first radiological screening. A representative case of a left posterior inferior cerebellar artery (PICA) pseudo-aneurysm caused by left vertebral artery’s dissection is reported. We show a unique complete collection of all 34 cases. Despite their rarity, TIPCs are associated with a significant morbidity and mortality rate, as high as 40–60%. Of the 22 patients with good neurological status (64.7%), we did not notice a significant correlation with regard to the location of the aneurysm, type of treatment, or clinical onset. Early recognition of a pseudo-aneurysm and adequate treatment seem to be the most important prognostic factor for these patients. Despite their rarity, TIPCs are associated with a significant morbidity and mortality rate. A TIPC should be suspected in case of delayed deterioration in head‐injured patient and should be investigated with angiography. Conservative management is worsened by poor prognosis and the goal of treatment is to exclude the aneurysm from circulation with surgical or endovascular methods as soon as possible.
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Affiliation(s)
- Mauro Palmieri
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy.
| | - Alessandro Pesce
- Santa Maria Goretti Hospital, Neurosurgery Division, Latina, Italy
| | - Giuseppa Zancana
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy
| | - Daniele Armocida
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy
| | - Aniello Maiese
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences SAIMLAL - "Sapienza" University, Rome, Italy
| | - Carlo Cirelli
- Department of Radiological, Oncological and Anatomopathological Sciences, Unit of Interventional Neuroradiology, "Sapienza" University of Rome, Umberto I University Hospital, Rome, Italy
| | - Antonio Santoro
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences SAIMLAL - "Sapienza" University, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences SAIMLAL - "Sapienza" University, Rome, Italy
| | - Alessandro Frati
- Human Neuroscience Department - Neurosurgery Division "Sapienza" University, Roma, Italy.,IRCCS "Neuromed", Pozzilli, IS, Italy
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14
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Grover PJ, Harris L, Qureshi AM, Rennie A, Robertson F, James G. Occult posterior inferior cerebellar artery dissection requiring endovascular treatment following pediatric head trauma: case report. J Neurosurg Pediatr 2021; 27:643-648. [PMID: 33836497 DOI: 10.3171/2020.11.peds18324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/02/2020] [Indexed: 11/06/2022]
Abstract
This is the eighth case report of a pediatric dissecting posterior inferior cerebellar artery aneurysm. The authors present the case of a 13-year-old boy who presented with posttraumatic posterior fossa subdural, subarachnoid, and intraventricular hemorrhage with hydrocephalus. Initial vascular imaging findings were negative; however, a high level of suspicion is necessary. The aneurysm was identified on day 20, after recurrence of hydrocephalus, and was treated with endovascular vessel sacrifice. The patient made a good recovery. It is important to consider arterial dissection in pediatric traumatic brain injury, especially with suspicious findings on initial CT scan and clinical presentation out of proportion to the mechanism of injury. Delayed vascular imaging is imperative for appropriate management.
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Affiliation(s)
- Patrick J Grover
- 1Department of Neurosurgery, National Hospital for Neurology and Neurosurgery; and
| | - Lauren Harris
- 1Department of Neurosurgery, National Hospital for Neurology and Neurosurgery; and
| | - Ayman M Qureshi
- 1Department of Neurosurgery, National Hospital for Neurology and Neurosurgery; and
| | - Adam Rennie
- 2Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
| | - Fergus Robertson
- 2Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
| | - Greg James
- 2Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
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15
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Greenbury CB. The Headache You Do Not Want to Miss. Clin Pediatr (Phila) 2020; 59:314-317. [PMID: 31777274 DOI: 10.1177/0009922819889984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Hejrati N, Ebel F, Guzman R, Soleman J. Posttraumatic cerebrovascular injuries in children. A systematic review. Childs Nerv Syst 2020; 36:251-262. [PMID: 31901968 DOI: 10.1007/s00381-019-04482-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Posttraumatic craniocervical vascular injuries in pediatric traumatic brain injury (TBI) are rare, and children-specific, evidence-based standards on screening and therapy of posttraumatic carotid-cavernous fistula (CCF), craniocervical artery dissections (CCAD), traumatic aneurysms (TA), and posttraumatic sinus venous thrombosis (SVT) is lacking. The aim of this review is to summarize the data on epidemiology, clinical presentation, and treatment of these traumatic lesions in a systematic manner. METHODS We performed a systematic PubMed search for records of CCF, CCAD, TA, and SVT related to pediatric TBI published until June 2019. RESULTS After screening 2439 records, 42 were included in the quantitative analysis. Incidences for CCAD in blunt TBI were 0.21% (range 0.02-6.82%). 11.7% (range 1.69-15.58%) of pediatric aneurysms were found to be traumatic of origin, whereas 38.2% (range 36.84-40%) of all pediatric SVT were due to blunt TBI. For all of the posttraumatic cerebrovascular pathologies, we found a clear male predominance with 68.75% in CCF, 63.4% in CCAD, 60% in TA, and 58.33% in SVT. Clinical presentation did not differ from the adult population with exception of young child. While there is only recommendation for the therapy of CCAD and SVT in the pediatric population, no such recommendation exists for the treatment of CCF's and TA's, and data from randomized controlled trials is lacking. CONCLUSION While these results show that posttraumatic CCF, CCAD, TA, and SVT are rarely encountered in children, misdiagnosis may have potentially drastic consequences due to a longer lifetime burden in the pediatric population. Awareness, early recognition, and prompt initiation of the appropriate therapy are essential to avoid morbidity and mortality. Further studies should focus on the development of clinical and radiological screening criteria of posttraumatic vascular lesions in children.
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Affiliation(s)
- Nader Hejrati
- Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Florian Ebel
- Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Division of Pediatric Neurosurgery, University Children's Hospital of Basel, Spitalstrasse 33, Basel, 4056, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.,Division of Pediatric Neurosurgery, University Children's Hospital of Basel, Spitalstrasse 33, Basel, 4056, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
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17
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Kim M, Lee HS, Lee S, Park JC, Ahn JS, Kwon DH, Kwun BD, Park W. Pediatric Intracranial Aneurysms: Favorable Outcomes Despite Rareness and Complexity. World Neurosurg 2019; 125:e1203-e1216. [PMID: 30794975 DOI: 10.1016/j.wneu.2019.01.280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/27/2019] [Accepted: 01/30/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Pediatric intracranial aneurysms (IAs) are rare and differ from their adult counterparts in terms of their aneurysmal characteristics, presentation, treatment, and outcomes. Their treatment is often more difficult and complex compared with that of adults. However, studies outlining the clinical effect of pediatric IAs remain sparse. METHODS We retrospectively reviewed the data from patients aged ≤18 years admitted to our hospital from 2000 to 2017 with a diagnosis of IAs. RESULTS From the sample of 8207 patients with an IA diagnosis, 26 patients with 33 IAs were involved. Our cohort included 17 males and 9 females, with a mean age of 12.5 years. The mean follow-up duration was 4 years and 3 months. Seven patients (26.92%) were assumed to have a traumatic origin for their IAs. Ruptured aneurysms were more common than unruptured ones (61.53% vs. 38.46%). Complex features were observed in 14 aneurysms (42.42%). Initially, microsurgical and endovascular treatment were both performed in 10 patients (38.46%). A good recovery was obtained in 16 patients (61.54%) as determined by the Glasgow outcome scale scores at the 6-month follow-up visits. The complete obliteration of aneurysms was observed in 17 patients (65.38%). Endovascular treatment was the initial treatment in 3 patients with incomplete obliteration. CONCLUSIONS The treatment of pediatric IAs is challenging and technically demanding owing to their discrete nature compared with adult IAs and the need for greater surgical skills. We found a male predominance, with internal carotid artery bifurcation as the most frequent location of the aneurysms. Despite the greater incidence of ruptured and complex aneurysm cases, many patients had experienced a good recovery at the 6-month follow-up examinations.
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Affiliation(s)
- Moinay Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Heui Seung Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seungjoo Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Do Hoon Kwon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byung Duk Kwun
- Department of Neurosurgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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18
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Policicchio D, Muggianu G, Dipellegrini G, Boccaletti R. Delayed diagnosis of post-traumatic aneurysm of distal anterior cerebral artery. Surg Neurol Int 2018; 9:222. [PMID: 30533269 PMCID: PMC6238328 DOI: 10.4103/sni.sni_252_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/27/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Traumatic intracranial aneurysms (TICA) are often associated with poor prognosis and should be diagnosed as soon as possible to prevent delayed intracranial hemorrhage and high rates of morbidity/mortality related to bleeding. Diagnosis requires a high index of suspicion. The goal of treatment is to exclude the aneurysm issue with surgical or endovascular methods. CASE DESCRIPTION We report the case of a 19-year-old boy who suffered a cranio-orbital trauma; 2 weeks after initial trauma he deteriorates with a new intracranial bleeding. Immediate angiography resulted negative. Delayed follow-up by magnetic resonance angiography showed an unruptured aneurysm of anterior cerebral artery that was successfully clipped. CONCLUSIONS A TICA should be suspected in case of delayed deterioration in head-injured patient, prompt diagnosis and treatment could improve prognosis and reduce morbidity and mortality.
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Affiliation(s)
- Domenico Policicchio
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola 1, 07100 Sassari (SS), Italy
| | - Giampiero Muggianu
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola 1, 07100 Sassari (SS), Italy
| | - Giosuè Dipellegrini
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Via Enrico De Nicola 1, 07100 Sassari (SS), Italy
| | - Riccardo Boccaletti
- Department of Neurosurgery, Regina Elena National Cancer Institute, Neurosurgery Department, Via Elio Chianesi 53, 00144, Rome, Italy
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19
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Garg M, Shambanduram S, Singh PK, Sebastian LJD, Sawarkar DP, Kumar A, Gaikwad S, Chandra P, Kale SS. Management of Pediatric Posterior Circulation Aneurysms—12-Year Single-Institution Experience. World Neurosurg 2018; 116:e624-e633. [DOI: 10.1016/j.wneu.2018.05.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
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20
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Ghali MG, Srinivasan VM, Cherian J, Wagner KM, Chen SR, Johnson J, Lam SK, Kan P. Multimodal Treatment of Intracranial Aneurysms in Children: Clinical Case Series and Review of the Literature. World Neurosurg 2018; 111:e294-e307. [DOI: 10.1016/j.wneu.2017.12.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/07/2017] [Accepted: 12/09/2017] [Indexed: 12/18/2022]
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21
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Ghali MGZ, Srinivasan VM, Cherian J, Kim L, Siddiqui A, Aziz-Sultan MA, Froehler M, Wakhloo A, Sauvageau E, Rai A, Chen SR, Johnson J, Lam SK, Kan P. Pediatric Intracranial Aneurysms: Considerations and Recommendations for Follow-Up Imaging. World Neurosurg 2017; 109:418-431. [PMID: 28986225 DOI: 10.1016/j.wneu.2017.09.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pediatric intracranial aneurysms (IAs) are rare. Compared with adult IAs, they are more commonly giant, fusiform, or dissecting. Treatment often proves more complex, and recurrence rate and de novo aneurysmogenesis incidence are higher. A consensus regarding the most appropriate algorithm for following pediatric IAs is lacking. METHODS We sought to generate recommendations based on the reported experience in the literature with pediatric IAs through a thorough review of the PubMed database, discussion with experienced neurointerventionalists, and our own experience. RESULTS Digital subtraction angiography (DSA) was utilized immediately post-operatively for microsurgically-clipped and endovascularly-treated IAs, at 6-12 months postoperatively for endovascularly-treated IAs, and in cases of aneurysmal recurrence or de novo aneurysmogenesis discovered by non-invasive imaging modalities. Computed tomographic angiography was the preferred imaging modality for long-term follow-up of microsurgically clipped IAs. Magnetic resonance angiography (MRA) was the preferred modality for following IAs that were untreated, endovascularly-treated, or microsurgically-treated in a manner other than clipping. CONCLUSIONS We propose incidental untreated IAs to be followed by magnetic resonance angiography without contrast enhancement. Follow-up modality and interval for treated pediatric IAs is determined by initial aneurysmal complexity, treatment modality, and degree of posttreatment obliteration. Recurrence or de novo aneurysmogenesis requiring treatment should be followed by digital subtraction angiography and appropriate retreatment. Computed tomography angiography is preferred for clipped IAs, whereas contrast-enhanced magnetic resonance angiography is preferred for lesions treated endovascularly with coil embolization and lesions treated microsurgically in a manner other than clipping.
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Affiliation(s)
- Michael George Zaki Ghali
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Jacob Cherian
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Louis Kim
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Adnan Siddiqui
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - M Ali Aziz-Sultan
- Vascular and Endovascular Neurosurgery, Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Froehler
- Department of Neurology, Vanderbilt School of Medicine, Nashville, Tennessee, USA
| | - Ajay Wakhloo
- Department of Radiology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Eric Sauvageau
- Baptist Neurological Institute, Lyerly Neurosurgery, Jacksonville, Florida, USA
| | - Ansaar Rai
- Department of Interventional Neuroradiology, West Virginia University, Morgantown, West Virginia, USA
| | - Stephen R Chen
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremiah Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Sandi K Lam
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
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22
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Sujijantarat N, Pierson MJ, Kemp J, Coppens JR. Staged Trapping of Traumatic Basilar Trunk Pseudoaneurysm: Case Report and Review of Literature. World Neurosurg 2017; 108:991.e7-991.e12. [PMID: 28866061 DOI: 10.1016/j.wneu.2017.08.144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Traumatic intracranial aneurysms (TICAs) of the posterior circulation in the pediatric populations are rare. Only a few reports in the literature document basilar artery TICA in the pediatric population. These cases were typically associated with a clival fracture and commonly diagnosed weeks to months after trauma. We present a case of a patient with a basilar TICA diagnosed after a motor vehicle collision treated with staged trapping and review of the literature. CASE DESCRIPTION We present a case of a 14-year-old boy who sustained a high-speed motor vehicle collision and developed a basilar trunk TICA identified on admission. Initially, the patient underwent craniotomy for proximal sacrifice of the basilar artery in hope for spontaneous thrombosis of the aneurysm through flow reversal. Endovascular options were reviewed and felt to be less feasible than surgical trapping. Due to continued filling through the right posterior communicating artery, the second surgery was performed to distally trap the aneurysm. The aneurysm was opened, showing some thrombosis and the absence of flow. Repeat magnetic resonance imaging did not reveal any new infarction, and the patient was discharged with neurologic improvement over time. At 1 year, he was able to ambulate unassisted and had a modified Rankin Scale score of 3. CONCLUSION Development of a TICA may be more acute than literature previously suggested. Treatment consists of a wide range of options and should be considered, especially in the pediatric population, to prevent rupture. Trapping can be performed safely if adequate collateral flow is present in the setting of a large basilar artery aneurysm.
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Affiliation(s)
| | - Matthew J Pierson
- Department of Neurosurgery, Saint Louis University, Saint Louis, Missouri, USA
| | - Joanna Kemp
- Department of Neurosurgery, Saint Louis University, Saint Louis, Missouri, USA
| | - Jeroen R Coppens
- Department of Neurosurgery, Saint Louis University, Saint Louis, Missouri, USA.
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23
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Ko HC, Koh JS, Shin HS, Lee SH, Ryu CW. Staged Endovascular Occlusion of a Posterior Communicating Artery-Cavernous Sinus Fistula and a Basilar Artery-Cavernous Sinus Fistula Associated with Traumatic Pseudoaneurysms: Technical Consideration and Literature Review. World Neurosurg 2017; 107:1051.e7-1051.e11. [PMID: 28842235 DOI: 10.1016/j.wneu.2017.08.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 08/09/2017] [Accepted: 08/11/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Traumatic injury of the posterior communicating artery or the basilar artery causing arteriovenous fistulae is rare. CASE DESCRIPTION Here we report an unusual case of the coincidence of a posterior communicating artery-cavernous sinus fistula and a basilar artery-cavernous sinus fistula associated with traumatic pseudoaneurysms of the posterior communicating and basilar arteries. The fistulas and pseudoaneurysms were obliterated completely after staged endovascular surgery via a transarterial and transvenous route. CONCLUSIONS To our knowledge, this is the first such report worldwide.
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Affiliation(s)
- Hak Cheol Ko
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Gangdong-gu, Seoul, Korea
| | - Jun Seok Koh
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Gangdong-gu, Seoul, Korea.
| | - Hee Sup Shin
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Gangdong-gu, Seoul, Korea
| | - Seung Hwan Lee
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Gangdong-gu, Seoul, Korea
| | - Chang Woo Ryu
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Gangdong-gu, Seoul, Korea
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24
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Varma S, Banh L, Smith P. Traumatic aneurysm of the cortical middle cerebral artery. BMJ Case Rep 2017; 2017:bcr-2017-219301. [PMID: 28228390 DOI: 10.1136/bcr-2017-219301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Shivesh Varma
- Department of Neurosurgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Lisa Banh
- Department of Neurosurgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Paul Smith
- Department of Neurosurgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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25
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Jung SH, Kim SH, Kim TS, Joo SP. Surgical Treatment of Traumatic Intracranial Aneurysms: Experiences at a Single Center over 30 Years. World Neurosurg 2016; 98:243-250. [PMID: 27836703 DOI: 10.1016/j.wneu.2016.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Traumatic intracranial aneurysm (tIA) is rare and is associated with high rates of morbidity and mortality. We describe our experiences with tIA at our institution. METHODS We retrospectively reviewed records from patients who underwent treatment for tIA between January 1986 and December 2015. RESULTS Data from 5532 patients with cerebral aneurysms between January 1986 and December 2015 were reviewed. Of these, 13 cases (0.23%) were tIA. Most occurred after blunt brain trauma (12/13; 92%). The most common location was the distal anterior cerebral artery (7/13; 53%) followed by the internal carotid artery (5/13; 38%). One patient had a tIA in the distal middle cerebral artery. Delayed intracerebral hemorrhage was the major presentation at the time of aneurysmal rupture (70%). Most patients underwent surgical treatment (10/12; 83.3%), which included clipping (5/10), trapping (3/10), aneurysmal excision and bypass (1/10), and aneurysmal excision and coagulation (1/10). In 2 cases, tIA located in the internal carotid artery was treated with coil embolization and detachable balloon occlusion, respectively. Most patients had good recovery (5/12; 41.7%); 3 patients and 1 patient had moderate and severe disability, respectively; 1 patient was in a vegetative state; and 2 patients died. CONCLUSIONS tIA is an uncommon complication of head trauma. tIA should be considered when unexpected new symptoms develop in patients with head trauma. Early diagnosis and prompt treatment could help to improve final clinical outcomes.
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Affiliation(s)
- Seung-Hoon Jung
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Sung-Hyun Kim
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Tae-Sun Kim
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Sung-Pil Joo
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
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26
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Endovascular Management of Paediatric Intracranial Aneurysms. Interv Neuroradiol 2016; 3:205-14. [DOI: 10.1177/159101999700300303] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/1997] [Accepted: 07/25/1997] [Indexed: 11/15/2022] Open
Abstract
The purpose of this paper is to discuss the radiological and clinical features of paediatric intracranial aneurysms including endovascular techniques currently being used for their therapy. Paediatric patients who presented with the diagnosis of intracranial aneurysm between August 1982 and February 1997 were included. The data were collected retrospectively. Clinical features included patient's age, sex, presentation, treatment and outcome. Radiologic features included location, size and number of aneurysms present. 21 patients (13 females and 8 males) ranging in age from 9 months to 16 years had intracranial aneurysms. Seventy six percent of the aneurysms were located in the anterior circulation and 24% in the posterior circulation. Seven patients (33%) had giant aneurysms and three patients (14%) had multiple aneurysms. Endovascular treatment was performed in six patients (29%) and neurosurgical treatment in eight patients (38%). Endovascular treatment included the use of coils and/or balloon occlusion. Of the remaining patients, two (9.5%) died prior to any surgical or radiological intervention. A further five patients (24%) were treated conservatively. Intracranial aneurysms in children demonstrate clinical and radiologic features that differ significantly from those seen in adults. There is a higher percentage of ICA termination aneurysms, giant aneurysms and post-traumatic aneurysms. However, aneurysms in children, like those in adults, can and have been successfully treated utilizing endovascular as well as neurosurgical techniques.
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27
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Joubert C, Esnault P, Veyrières JB, Dagain A. Posttraumatic retroclival subarachnoid hemorrhage: what to do in an emergency? Am J Emerg Med 2016; 34:2257.e3-2257.e5. [PMID: 27260554 DOI: 10.1016/j.ajem.2016.05.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 05/18/2016] [Indexed: 12/17/2022] Open
Affiliation(s)
- C Joubert
- Department of Neurosurgery, Military Hospital Sainte Anne, 83000 Toulon, France.
| | - P Esnault
- Department of Intensive Care, Military Hospital Sainte Anne, 83000 Toulon, France
| | - J-B Veyrières
- Department of Interventional Neuroradiology, Military Hospital Sainte Anne, 83000 Toulon, France
| | - A Dagain
- Department of Neurosurgery, Military Hospital Sainte Anne, 83000 Toulon, France
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Liu P, Yang M, Cai M, Qin J, Pan L. Treatment of Pediatric Traumatic Intracranial Pseudoaneurysm Using Endovascular Covered Stent: Three Case Reports. World Neurosurg 2015; 88:693.e1-693.e6. [PMID: 26724623 DOI: 10.1016/j.wneu.2015.12.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/08/2015] [Accepted: 12/08/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pediatric traumatic intracranial pseudoaneurysm (TIPA) is a relatively rare clinical entity resulting from blunt, penetrating, or iatrogenic head trauma. The diagnosis, management, and prognosis of patients with pediatric TIPA is not well understood. Surgical craniotomy for TIPA is a high-risk operation. Advancements in minimally invasive technology have allowed for endovascular reconstruction of TIPA. CASE DESCRIPTION We present our experience with use of endovascular covered stents for treatment of 3 pediatric patients with TIPA. The clinical and radiologic characteristics are presented. No procedure-related complications or deaths occurred during follow-up. CONCLUSIONS In this study, the use of the Willis covered stent was associated with favorable prognoses in 3 patients with TIPA. No major complications were encountered during follow-up. The Willis covered stent appears to be a viable therapeutic modality in these patients. A definitive prognosis assessment will necessitate prospective clinical trials with longer duration of follow-up.
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Affiliation(s)
- Peng Liu
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command, Southern Medical University, Wuhan, China
| | - Ming Yang
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command, Southern Medical University, Wuhan, China
| | - Mingjun Cai
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command, Southern Medical University, Wuhan, China
| | - Jie Qin
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command, Southern Medical University, Wuhan, China
| | - Li Pan
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command, Southern Medical University, Wuhan, China.
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Munakomi S, Tamrakar K, Chaudhary P, Bhattarai B, Cherian I. Case Report: Traumatic anterior cerebral artery aneurysm in a 4-year old child. F1000Res 2015; 4:804. [PMID: 27635218 PMCID: PMC5017288 DOI: 10.12688/f1000research.7028.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 11/29/2022] Open
Abstract
Traumatic intracranial aneurysm in the proximal part of the anterior cerebral artery in the pediatric population has not been documented so far. Here we report the case of a 4 year-old child who developed a pseudo-aneurysm after minor head trauma and was managed successfully with trapping of the aneurysm. A ventriculo-peritoneal shunt was placed as the child became dependent on extraventricular drain during the post-operative period. The patient made excellent recovery in neurological status within 1 month of post-operative clinical follow up.
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Yatomi K, Oishi H, Yamamoto M, Suga Y, Nonaka S, Yoshida K, Arai H. Radiological changes in infantile dissecting anterior communicating artery aneurysm treated endovascularly. A case report and five-year follow-up. Interv Neuroradiol 2014; 20:796-803. [PMID: 25496693 DOI: 10.15274/inr-2014-10093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 05/31/2014] [Indexed: 11/12/2022] Open
Abstract
Intracranial aneurysms are extremely rare in infants, and to our knowledge only seven infants treated for ruptured spontaneous dissecting aneurysms have been reported. Good outcomes have been achieved with endovascular treatment of infantile aneurysm. We the endovascular treatment of a one-month-old girl for ruptured dissecting aneurysm located in the anterior communicating artery, and the unique radiological changes that were observed during the perioperative and follow-up periods. These changes suggest that blood coagulation and fibrinolytic response play a part in the repair and healing processes of dissecting aneurysms. Careful neuroradiological surveys are needed for pediatric dissecting aneurysms treated endovascularly.
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Affiliation(s)
- Kenji Yatomi
- Departments of Neurosurgery, Juntendo University School of Medicine; Tokyo, Japan -
| | - Hidenori Oishi
- Departments of Neurosurgery and Neuroendovascular Therapy, Juntendo University School of Medicine; Tokyo, Japan
| | - Munetaka Yamamoto
- Departments of Neurosurgery, Juntendo University School of Medicine; Tokyo, Japan
| | - Yasuo Suga
- Departments of Neurosurgery, Juntendo University School of Medicine; Tokyo, Japan
| | - Senshu Nonaka
- Departments of Neurosurgery, Juntendo University School of Medicine; Tokyo, Japan
| | - Kensaku Yoshida
- Department of Neurosurgery, Tokyo Metropolitan Hiroo Hospital; Tokyo, Japan
| | - Hajime Arai
- Departments of Neurosurgery, Juntendo University School of Medicine; Tokyo, Japan
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Anami H, Aihara Y, Kawashima A, Yamaguchi K, Nagahara A, Okada Y. A case report of a pediatric traumatic aneurysm with arteriovenous (A-V) fistula CASE-BASED UPDATE. Childs Nerv Syst 2014; 30:2003-8. [PMID: 25227169 DOI: 10.1007/s00381-014-2551-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/03/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traumatic intracranial aneurysms (TICAs) are rare, representing less than 5 % of all intracranial aneurysms. Most TICAs are located within the anterior circulation, and less than 10 % of TICAs occur in the posterior circulation. Histopathologically, most TICAs are false aneurysms and have a high risk of rupture or re-bleeding. When they are discovered, careful observation or treatment may be required. Once they are enlarged, they have a high risk of rupture, and immediate treatment is essential. CASE REPORT For the first time in the literature, we report a rare case of an 8-year-old boy with a TICA in anterior inferior cerebellar artery (AICA) and arteriovenous (A-V) fistula after severe head trauma. Trapping of AICA and resection of the aneurysm was performed. Postoperatively, he has peripheral facial palsy but is otherwise neurologically normal. CONCLUSION Surgical treatment for traumatic aneurysms is challenging because most of TICAs are histopathologically pseudoaneurysms. It may be technically difficult to perform direct surgery of aneurysms especially located in the posterior circulation, but when the treatment is successful, the outcome was favorable.
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Affiliation(s)
- Hidenori Anami
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho Shinjuku-ku, Tokyo, 162-8666, Japan
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Wewel J, Mangubat EZ, Muñoz L. Iatrogenic traumatic intracranial aneurysm after endoscopic sinus surgery. J Clin Neurosci 2014; 21:2072-6. [PMID: 25128281 DOI: 10.1016/j.jocn.2014.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 05/17/2014] [Indexed: 10/24/2022]
Abstract
Iatrogenic traumatic intracranial aneurysms are rare, but their clinical impact is significant secondary to their risk of intracranial hemorrhage and in their frequent complexity in management. We report an adult patient with a history of chronic sinusitis who, while undergoing elective endoscopic polypectomy, suffered an iatrogenic injury to an A2 segment branch of the left anterior cerebral artery, resulting in a pseudoaneurysm. Management included endovascular coiling and a bicoronal craniotomy approach, using a split-thickness cranial graft and abdominal fat graft to repair the associated left cribriform plate defect.
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Affiliation(s)
- Joshua Wewel
- Rush Professional Office Building, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612, USA.
| | - Erwin Zeta Mangubat
- Rush Professional Office Building, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612, USA
| | - Lorenzo Muñoz
- Rush Professional Office Building, 1725 W. Harrison Street, Suite 855, Chicago, IL 60612, USA
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Garg K, Singh PK, Sharma BS, Chandra PS, Suri A, Singh M, Kumar R, Kale SS, Mishra NK, Gaikwad SK, Mahapatra AK. Pediatric intracranial aneurysms--our experience and review of literature. Childs Nerv Syst 2014; 30:873-83. [PMID: 24322606 DOI: 10.1007/s00381-013-2336-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Intracranial aneurysms in children are not as common as in adults and there are many differences in the etiology, demographic variables, aneurysm location, aneurysm morphological characteristics, clinical presentation, and outcome in pediatric and adult intracranial aneurysms. METHODS All children (≤18 years) suffering from intracranial aneurysm managed at our center from July 2001 through June 2013 were included in the study, and the details of these patients were retrieved from the computerized database of our hospital. OBSERVATIONS A total of 62 pediatric patients were treated for 74 aneurysms during the study period and constituted 2.3% of all intracranial aneurysms treated during the same period. The mean age at presentation was 13.5 years. Headache (82%) was the commonest presenting feature; other symptoms included seizures (21%), ictal loss of consciousness (27%), and motor/cranial nerve deficits (22.6%). Computed tomogram revealed subarachnoid hemorrhage in 58% of patients. Eighty-two percent of aneurysms were in anterior circulation. Sixty-seven percent of aneurysms were complex aneurysms. Fifty-eight percent of patients underwent surgical intervention while 30% underwent endovascular procedures. Twenty-one percent of the patients developed vasospasm. There was no postoperative mortality. Favorable outcome was seen in 72% of the patients. CONCLUSIONS Pediatric intracranial aneurysms are uncommon as compared to in adult patients. Seizures and cranial nerve involvement are seen more often as the presenting features in children. Posterior circulation aneurysms are more common in children, as are the internal carotid artery bifurcation aneurysms. There is high incidence of giant, posttraumatic, and mycotic aneurysms in children.
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Affiliation(s)
- Kanwaljeet Garg
- Department of Neurosurgery, Cardio-Neuro Centre, All India Institute of Medical Sciences, Room No 720, New Delhi, India
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Altali K, Arruza L, López-Ibor L, Aleo E. Effective coil embolization of intracavernous carotid artery pseudoaneurysm with parental artery preservation following severe head trauma in a pediatric patient. Childs Nerv Syst 2014; 30:967-70. [PMID: 24193149 DOI: 10.1007/s00381-013-2312-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 10/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Intracranial traumatic pseudoaneurysms are rare in children. If left untreated, mortality rate can be as high as 50% due to delayed rupture and disastrous bleeding. Endovascular embolization is considered the preferred treatment option because of its minimal invasiveness and negligible mortality. However, exclusion of the pseudoaneurysm with preservation of the parental vessel is not always possible. In comparison with peripheral aneurysms, intracavernous internal carotid artery lesions are technically more challenging with both open surgery and endovascular techniques. CASE REPORT We report the case of a successful two-stage coil embolization of a traumatic intracavernous carotid artery pseudoaneurysm with preservation of parental vessel in a 6-year-old boy. CONCLUSION Endovascular embolization with parental vessel preservation should be considered the first treatment option for traumatic intracavernous internal carotid artery pseudoaneurysms in children. Although treatment of pseudoaneurysms in this location may be technically difficult, it is feasible in experienced hands.
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Affiliation(s)
- Kinda Altali
- Department of Pediatrics, Hospital Clinico San Carlos, Profesor Martin Lagos SN, 28040, Madrid, Spain
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35
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Gemmete JJ, Toma AK, Davagnanam I, Robertson F, Brew S. Pediatric Cerebral Aneurysms. Neuroimaging Clin N Am 2013; 23:771-9. [DOI: 10.1016/j.nic.2013.03.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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36
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Mohan IV. Current optimal assessment and management of carotid and vertebral spontaneous and traumatic dissection. Angiology 2013; 65:274-83. [PMID: 23401625 DOI: 10.1177/0003319712475154] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dissection of the internal carotid or vertebral artery has been recognized as a cause of stroke in young patients. It is disproportionate in its representation as a cause of stroke in this age group. Intimal tears, intramural hematomas, and dissection aneurysms may be the result of trauma or may occur spontaneously. Spontaneous dissection may be the result of inherent arterial weakness or in association with other predisposing factors. Clinical diagnosis is often difficult, but increased awareness and a range of modern investigations such as computerized tomography or magnetic resonance imaging may aid in diagnosis. Management options include antiplatelet therapy, anticoagulation, thrombolysis, and surgical or endovascular procedures. Prognosis is variable, and dissection may be asymptomatic but may lead to profound neurological deficit and death.
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Affiliation(s)
- Irwin V Mohan
- 1Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
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37
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Mao Z, Wang N, Hussain M, Li M, Zhang H, Zhang Q, Zhang P, Zhi X, Ling F. Traumatic intracranial aneurysms due to blunt brain injury-a single center experience. Acta Neurochir (Wien) 2012; 154:2187-93; discussion 2193. [PMID: 22975866 DOI: 10.1007/s00701-012-1487-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 08/15/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Traumatic intracranial aneurysms (TICAs) have previously been described in literature. However, the evidence of TICAs secondary to blunt brain injury have not been elucidated well, with most of the conclusions coming from isolated case reports. We have attempted to examine the epidemiology, classification, clinical presentation, therapeutic modalities, and outcomes of TICAs with our series of patients at the neurosurgery department of Xuanwu Hospital, China. METHODS We reviewed our aneurysm database from January 1, 2005 to December 31, 2011. In particular, patients with TICAs secondary to blunt brain injury were reviewed. Variables assessed included age, sex, causes of blunt brain injury, skull fracture, location, classification, clinical presentation, time elapsed to arrive at diagnoses, treatment, and eventual outcome. Based on our assessment, we arrived at a modified classification scheme to categorize these aneurysms. RESULTS We reviewed 2335 patients with cerebral aneurysm from January 1, 2005 to December 31, 2011. Of these, 15 patients (0.64 %) with traumatic aneurysms secondary to blunt brain injury were identified.Motor vehicle accidents (MVA) were observed to be the most common cause of injury (10 patients, 66.7 %), followed by TICAs sustained after falling down (5 patients, 33.3 %). The most common symptom at presentation was epistaxis (6 patients, 40 %), followed by ophthalmic problems (6 patients, 40 %), with both presentations seen in 1 patient. The most common diagnostic modality used was DSA in 12 patients (80 %) followed by CTA in 2 patients (13.3 %). Infraclinoid TICAs were seen in 9 patients (60 %), whereas supraclinoid TICAs were seen in 5 patients (33.3 %), with perifalx TICAs seen in 1 patient. Endovascular intervention therapies were performed in 11 patients (73.3 %), bypass surgery and trapping in 2 (13.3 %), transnasal endoscopic approach in combination with balloon assisted in 2 patients. At discharge, 2 patients had poor clinical outcomes (13.3 %), 5 had fair (33.3 %),and 8 resulted with good outcomes (53.3 %). CONCLUSIONS TICAs arising secondary to blunt brain injury account for 0.64 % of all cerebral aneurysms. Infraclinoid, supraclinoid ICA and perifalx TICAs are the most common aneurysms arising from blunt brain injury. Our study further shows that traumatic patients presenting with recurrent epistaxis, oculomotor nerve palsy, and delayed intracranial hemorrhage should receive cerebroangiography as soon as possible. An early diagnosis and proper treatment could prove to be helpful in terms of improving final clinical outcome.
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Egemen E, Massimi L, Di Rocco C. Iatrogenic intracranial aneurysms in childhood: case-based update. Childs Nerv Syst 2012; 28:1997-2004. [PMID: 22945805 DOI: 10.1007/s00381-012-1907-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 08/24/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Iatrogenic aneurysms are very rare in children. Characteristic clinical manifestations are variable and asymptomatic course is possible especially for fusiform dilatation of internal carotid artery. Even though radiological diagnosis is easy, the management of iatrogenic intracranial aneurysm is still a subject for discussion. METHODS Fusiform dilatations of internal carotid artery were diagnosed on three pediatric patients during follow-up imaging after primary surgery for suprasellar-parasellar tumor. All patients were asymptomatic. Conservative treatment was proposed because the lesion did not show any progression in subsequent examinations. Patients are stable under conservative treatment. CONCLUSIONS Iatrogenic aneurysm may have an unusual presentation and their therapy still remains unclear. Fusiform dilatation of internal carotid artery rarely causes symptoms and there is no published paper of subarachnoid bleeding. Treatment would be difficult, since the main arterial branches arise from the dilated carotid segment. Conservative treatment is a choice only if aneurysm has no progression or in case of spontaneous healing. Intervention should be performed only in case of progression or if the aneurysm becomes symptomatic.
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Affiliation(s)
- Emrah Egemen
- Neurosurgery Department, Gazi University Medical School, Beşevler, 06500 Ankara, Turkey.
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Mehrotra A, Nair AP, Das KK, Srivastava A, Sahu RN, Kumar R. Clinical and radiological profiles and outcomes in pediatric patients with intracranial aneurysms. J Neurosurg Pediatr 2012; 10:340-6. [PMID: 22920296 DOI: 10.3171/2012.7.peds11455] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Intracranial aneurysms are extremely uncommon in the pediatric population, their characteristics are not well studied, and certain features make them unique. The authors analyzed pediatric patients with aneurysms to try to understand their clinical, radiological, and outcome profile. METHODS Sixty-three pediatric patients (≤ 18 years of age) with ages ranging from 4 to 18 years and features (clinical and radiological) suggestive of aneurysm presented to, and were treated at, the authors' center in the past 20 years (1991-2011). Included in the present study were only those patients who underwent surgical intervention, and thus data for 57 patients were analyzed. RESULTS Seventy-three aneurysms in 57 patients were surgically treated. There was a slight female predominance (M/F 1:1.2), and the mean age among all patients was 12.69 ± 3.75 years. Fifty patients (87.72%) presented with subarachnoid hemorrhage, 4 (7.02%) with mass effect, and 3 (5.26%) with seizure. On presentation the majority of patients (45 [78.95%]) had a good clinical grade. Eleven patients had multiple aneurysms. The internal carotid artery (ICA) bifurcation was the most common aneurysm site (18 cases [24.66%]), followed by the middle cerebral artery (MCA) bifurcation (11 cases [15.07%]). At a mean follow-up of 18.58 ± 10.71 months (range 1.5-44 months), 44 patients (77.19%) had a favorable outcome, and 5 patients had died. CONCLUSIONS Pediatric patients with intracranial aneurysms most commonly presented with subarachnoid hemorrhage, and there was a slight female predominance. The ICA bifurcation followed by the MCA bifurcation was the most common aneurysm site. The incidence of posterior circulation and giant aneurysms is higher in pediatric patients than in the adult population. Children tend to present with better clinical grades and have better overall survival results and good functional outcomes.
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Affiliation(s)
- Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
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Aeron G, Abruzzo TA, Jones BV. Clinical and Imaging Features of Intracranial Arterial Aneurysms in the Pediatric Population. Radiographics 2012; 32:667-81. [DOI: 10.1148/rg.323105224] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mitchell B, Dash D, Humphries W, Mawad M. De novo intracranial aneurysm formation following endovascular treatment of giant aneurysm in an infant: case report. Childs Nerv Syst 2012; 28:645-8. [PMID: 22167265 DOI: 10.1007/s00381-011-1647-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 11/21/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Bartley Mitchell
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA.
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42
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Head and Spinal Cord Injury: Diagnosis and Management. Neurol Clin 2012; 30:241-76, ix. [DOI: 10.1016/j.ncl.2011.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
INTRODUCTION Pediatric stroke, while increasingly recognized among practitioners as a clinically significant, albeit infrequent entity, remains challenging from the viewpoint of clinicians and researchers. DISCUSSION Advances in neuroimaging have revealed a higher prevalence of pediatric stroke while also provided a safer method for evaluating the child's nervous system and vasculature. An understanding of pathogenic mechanisms for pediatric stroke requires a division of ages (perinatal and childhood) and a separation of mechanism (ischemic and hemorrhagic). This article presents a review of the current literature with the recommended divisions of age and mechanism. CONCLUSION Guidelines for treatment, though limited, are also discussed.
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44
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Fusco MR, Harrigan MR. Cerebrovascular dissections: a review. Part II: blunt cerebrovascular injury. Neurosurgery 2011; 68:517-30; discussion 530. [PMID: 21135751 DOI: 10.1227/neu.0b013e3181fe2fda] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Traumatic cerebrovascular injury (TCVI) is present in approximately 1% of all blunt force trauma patients and is associated with injuries such as head and cervical spine injuries and thoracic trauma. Increased recognition of patients with TCVI in the past quarter century has been because of aggressive screening protocols and noninvasive imaging with computed tomography angiography. Extracranial carotid and vertebral artery injuries demonstrate a spectrum of severity, from intimal disruption to traumatic aneurysm formation or vessel occlusion. The most common intracranial arterial injuries are carotid-cavernous fistulae and traumatic aneurysms. Data on the long-term natural history of TCVI are limited, and management of patients with TCVI is controversial. Although antithrombotic medical therapy is associated with improved neurological outcomes, the optimal medication regimen is not yet established. Endovascular techniques have become more popular than surgery for the treatment of TCVI; endovascular options include stenting of dissections, intra-arterial thrombolysis for acute ischemic stroke caused by trauma, and embolization of traumatic aneurysms.
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Affiliation(s)
- Matthew R Fusco
- Department of Surgery, Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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45
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Liang JT, Huo LR, Bao YH, Zhang HQ, Wang ZY, Ling F. Intracranial aneurysms in adolescents. Childs Nerv Syst 2011; 27:1101-7. [PMID: 21210131 DOI: 10.1007/s00381-010-1334-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Accepted: 11/02/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Intracranial aneurysms are extremely uncommon in adolescents. This study was undertaken to assess the clinical and radiological characteristics and clarify the choice of therapeutic strategies of intracranial aneurysms in adolescents with age range from 15 to 18 years. METHODS From our dedicated aneurysmal databank between October 1985 and July 2008, we reviewed 16 consecutive adolescents who had 20 intracranial aneurysms. RESULTS Ten boys and six girls (male/female ratio = 1.67:1; mean age 16.78 ± 1.18 years) were included in the present study. Intracranial aneurysms in adolescents constituted 0.91% of all intracranial aneurysms. It was found that 25% of the lesions were in the posterior circulation, while 75% of the lesions were in the anterior circulation, and 25% developed on the middle cerebral artery (MCA). Half of the patients presented with subarachnoid hemorrhage and others mainly presented with mass effect such as weakness in the extremities, diplopia, and dysfunction of eye movement. Eight cases underwent endovascular treatment: including GDC therapy in five patients, parental artery occlusion in two patients, and cover stent implantation in one patient with pseudoaneurysm of the cavernous segment of the left internal carotid artery. Four patients received microsurgical therapy: aneurismal neck clipping for two patients and extracranial-intracranial (EC-IC) bypass and trapping of complex aneurysms in MCA for the other two patients. Four patients did not receive microsurgical or endovascular therapy, including a boy whose aneurysm spontaneously thrombosed preoperatively and a girl who died before operation because of rerupture of aneurysm. Two patients did not undergo therapy owing to the high operative risk. All of the patients who received therapy had favorable outcome (GOS 4 or 5) at discharge and at follow-up. CONCLUSIONS Intracranial aneurysms in adolescents differ from those in adults in many ways including the following: male predominance; high incidence of large or giant, traumatic, dissecting, and fusiform aneurysms; high incidence of aneurysms in the posterior circulation; high incidence of spontaneous thrombosis; better Hunt-Hess grade at presentation; and better therapeutic outcome. Both microsurgical approaches and endovascular treatment were effective. For some giant, complex intracranial aneurysms, parent artery occlusion or EC-IC bypass is the best treatment choice.
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Affiliation(s)
- Jian-tao Liang
- Department of Neurosurgery, Peking University Third Hospital, Haidian District, Beijing, 100191, China
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Trapping with high-flow bypass for a traumatic giant pseudoaneurysm of the supraclinoid carotid artery in an adolescent: case report. Childs Nerv Syst 2011; 27:681-4. [PMID: 21279362 DOI: 10.1007/s00381-011-1397-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 01/13/2011] [Indexed: 10/18/2022]
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Abstract
Intracranial pediatric aneurysms arising in children are rare. The treatment of these lesions requires both an understanding of their unique features as well as surgical, interventional, and pediatric critical care expertise offered through a multidisciplinary setting. The patient population, clinical presentation, complications, and trends in treatments are discussed in this article.
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Affiliation(s)
- Brian J Jian
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Avenue, Room M779, San Francisco, CA 94143-0112, USA
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Ogilvy CS, Tawk RG, Mokin M, Yang X, Levy EI, Hopkins LN, Siddiqui AH. Stent-assisted coiling treatment of pediatric traumatic pseudoaneurysm resulting from tumor surgery. Pediatr Neurosurg 2011; 47:442-8. [PMID: 22777182 DOI: 10.1159/000339353] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 05/07/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Traumatic intracranial pseudoaneurysms in children are typically the result of blunt or penetrating head injury. There are isolated reports of pseudoaneurysm as the result of intracranial aneurysm surgery in both adults and children. Treatment of these lesions, both surgically and endovascularly, can be complicated due to the known variability of arterial wall thickness in traumatic pseudoaneurysms. CASE REPORT We describe a child who underwent successful craniopharyngioma resection following staged surgical procedures. Follow-up imaging 8 months after the operation demonstrated an enlarging pseudoaneurysm of the left supraclinoid carotid artery. The lesion was successfully treated with stenting of the vessel and coil placement between the stent and the aneurysmal segment of the artery. Follow-up angiographic imaging 6 months later revealed complete obliteration of the aneurysm and normalization of the carotid artery lumen. CONCLUSION To our knowledge, this is the first report of a pseudoaneurysm secondary to a surgical intervention in childhood that was treated with stent-assisted coiling. This strategy of vascular reconstruction is increasingly used in adults and appears safe to implement in the pediatric population. However, the long-term outcomes and the value of using an antiplatelet regimen in this young population are still to be determined.
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Haji FA, Boulton MR, de Ribaupierre S. Blister-like supraclinoid internal carotid artery pseudoaneurysm in a 15-year-old male: case report and review of the literature. Pediatr Neurosurg 2011; 47:449-54. [PMID: 22777210 DOI: 10.1159/000339355] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 05/07/2012] [Indexed: 11/19/2022]
Abstract
With an incidence of less than 1-3 per million, pediatric aneurysms are rare clinical entities. A traumatic etiology is implicated in a large proportion of these cases, leading to the formation of both 'false' and 'true' aneurysms. These occur most often in the distal circulation, but have also been described in the supraclinoid distal internal carotid artery (ICA). Blood blister aneurysms are also found in this location; however, they have not been described in the pediatric population. We report the case of a 15-year-old male who presented following cranial trauma with diffuse basal subarachnoid hemorrhage and limited additional intracranial pathology. Computed tomography angiography demonstrated a small, 2-mm blister-like aneurysm arising from the dorsal surface of the left supraclinoid ICA at a non-branching site. Despite early endovascular treatment with Guglielmi detachable coils, the lesion continued to grow over subsequent studies, necessitating open surgical clipping. At the time of surgery, gross pathology of the native ICA was observed, raising the possibility of a preexisting blood-blister aneurysm. We review the epidemiology, pathophysiology and diagnostic considerations of these lesions. The endovascular and surgical management of these complex non-branching supraclinoid ICA aneurysms is also discussed.
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Affiliation(s)
- Faizal Aminmohamed Haji
- Division of Neurosurgery, Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ont., Canada.
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Krings T, Geibprasert S, terBrugge KG. Pathomechanisms and treatment of pediatric aneurysms. Childs Nerv Syst 2010; 26:1309-18. [PMID: 20033187 DOI: 10.1007/s00381-009-1054-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 11/16/2009] [Indexed: 10/20/2022]
Abstract
Pediatric aneurysms are rare diseases distinct from classical adult aneurysms and therefore require different treatment strategies. Apart from saccular aneurysms that are more commonly found in older children, three major pathomechanisms may be encountered: trauma, infection, and dissection. The posterior circulation and more distal locations are more commonly encountered in children compared to adults, and there is an overall male predominance. Clinical findings are not only confined to subarachnoid hemorrhage but may also comprise mass effects, headaches or neurological deficits. In traumatic aneurysms, the skull base and distal anterior communicating artery are commonly affected, and the hemorrhage occurs often delayed (2-4 weeks following the initial trauma). Infectious aneurysms are mostly bacterial in origin, and hemorrhage occurs early after a septic embolic shower. Dissecting aneurysms are the most often encountered aneurysm type in children and can lead to mass effect, hemorrhage, or ischemia depending on the fate of the intramural hematoma. Treatment strategies in pediatric aneurysms include endosaccular coil treatment only for the "classical berry-type" aneurysms; in the other instances, parent vessel occlusion, flow reversal, surgical options, or a combined treatment with bypass and parent vessel occlusion have to be contemplated.
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Affiliation(s)
- Timo Krings
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, UHN, University of Toronto, 399 Bathurst St., 3MCL-429, Toronto, ON, M5T 2S8, Canada.
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