TRAUMATIC INTRACRANIAL ANEURYSMS IN CHILDHOOD AND ADOLESCENCE - CASE-REPORTS AND REVIEW OF THE LITERATURE

We report four pediatric traumatic intracranial aneurysms occurring be fore the age of 10 years. Two of these aneurysms were the result of cl osed head injury. The remaining two were iatrogenic aneurysms which oc curred in unusual circumstances. These four children represent 33% of the pediatric intracranial aneurysms seen at the Children's Hospital o f Eastern Ontario from 1974 to 1992. Diagnosis of traumatic intracrani al aneurysms requires a high index of suspicion: any head-injured or p ostoperative child who experiences delayed neurologic deterioration, o r who fails to improve as expected following treatment, should promptl y undergo diagnostic intracranial imaging. Documented subarachnoid hem orrhage, intracerebral or intraventricular hemorrhage, or subdural hae matoma in this clinical setting should be further investigated by cere bral angiography to exclude a traumatic aneurysm or other vascular les ion. Traumatic aneurysms typically arise at the skull base or from dis tal anterior or middle cerebral arteries or branches consequent to dir ect mural injury or to acceleration-induced shear. Reported traumatic aneurysms account for 14%-39% of all pediatric aneurysms. Iatrogenic a neurysms also occur with unecpected frequency during childhood and ado lescence. Pediatric traumatic cerebral aneurysms may present early or late. Most present early with intracranial hemorrhage. Late presentati on occurs infrequently, typically as an aneurysmal mass. Once diagnose d, these aneurysms should be promptly treated by craniotomy employing routine microsurgical techniques, or in some cases, by endovascular de tachable balloon techniques. Delay in operative treatment entails sign ificant risks of repeated hemorrhage and death. Outcome in these child ren is primarily determined by the extent of traumatic cerebral injury and the preoperative clinical status. The latter directly depends upo n diagnosis of the aneurysm prior to either initial or repeated hemorr hage.