Pediatric cerebral aneurysms

Object. The exceptional pediatric aneurysm can be distinguished from its ad ult counterpart by its location and size; however, patient outcomes remain difficult to evaluate based on the published literature. Methods. Twenty-two children. all consecutively treated in three neurosurge ry departments, were included in this study. Each patient's preoperative st atus was determined according to the Hunt and Hess classification. Routine computerized tomography scanning and angiography were performed in all chil dren on the 10th postoperative day. Each patient's clinical status was eval uated 2 to 10 years postoperatively by applying the Glasgow Outcome Scale ( GOS). Twenty-one children presented with a subarachnoid hemorrhage (SAH) and one child harbored an asymptomatic giant aneurysm. Thirteen patients were in go od preoperative grade (Hunt and Hess Grades I to III) and eight in poor pre operative grade (Hunt and Hess Grade IV or V). The symptomatic aneurysms we re located on the internal carotid artery bifurcation (36.4%); middle cereb ral artery (36.4%), half of which were found on the distal portion, anterio r communicating artery (18.2%); and within the vertebrobasilar system (9.1% ). A giant aneurysm was observed in 14% of patients. Overall outcome was fa vorable (GOS Score 5) in 14 children (63.6%) and death occurred in five (22 .7%). Causes of unfavorable outcome included the initial SAH in four childr en, a complication in procedure in three children, and edema in one child. Conclusions. Pediatric aneurysms have a specific distribution unlike that o f aneurysms in the adult population. The incidence of giant aneurysms and o utcomes were similar to those in the adult population. The major cause of p oor outcome was the initial SAH, in particular, the high proportion of rebl eeding possibly due to a delay in diagnosis.