Aneurysms are relatively rare in the pediatric population and tend to include a greater proportion of large and giant lesions. A subset of these large and giant
aneurysms are not amenable to direct surgical clipping and require complex treatment strategies and revascularization techniques. There are limited data available on the management of these lesions in the pediatric population. This study was undertaken to evaluate the outcome of treatment of large and giant
aneurysms that required microsurgical revascularization and vessel sacrifice in this population.
METHODS: The authors identified 27 consecutive patients (19 male and 8 female) with 29
aneurysms. The mean age of the patients at the time of treatment was 11.5 years (median 13 years, range 1-17 years). Five patients presented with
subarachnoid hemorrhage, 11 with symptoms related to mass effect, 2 with
stroke, and 3 with
seizures; in 6 cases, the
aneurysms were incidental findings.
Aneurysms were located along the internal carotid artery (n = 7), posterior cerebral artery (PCA) (n = 2), anterior cerebral artery (n = 2), middle cerebral artery (MCA) (n = 14), basilar artery (n = 2), vertebral artery (n = 1), and at the vertebrobasilar junction (n = 1). Thirteen were giant
aneurysms (45%). The majority of the
aneurysms were fusiform (n = 19, 66%), followed by saccular (n = 10, 34%). Three cases were previously treated using microsurgery (n = 2) or an
endovascular procedure (n = 1). A total of 28 revascularization procedures were performed, including superficial temporal artery (STA) to MCA (n = 6), STA to PCA (n = 1), occipital artery to PCA (n = 1), extracranial-intracranial (EC-IC) bypass using radial artery graft (n = 3), EC-IC using a saphenous vein graft (n = 7), STA onlay (n = 3), end-to-end anastomosis (n = 1), and in situ bypasses (n = 6). Perioperative
stroke occurred in 4 patients, but only one remained dependent (Glasgow Outcome Scale [GOS] score 3). At a mean clinical follow-up of 46 months (median 14 months, range 1-232 months), 26 patients had a good outcome (GOS score 4 or 5). There were no deaths. Five patients had documented occlusion of the bypass graft. The majority of
aneurysms (n = 24) were obliterated at last follow-up. There was a single case of a residual
aneurysm and one case of recurrence. Angiographic follow-up was unavailable in 3 cases.
CONCLUSIONS: