Article Figures & Data
Figures
- Fig 1.
Clinical symptoms at presentation in relation to the type of aneurysm (percentages).
- Fig 2.
Vascular location of 103 aneurysms in relation to their type (percentages).
- Fig 3.
Aneurysm subtype expressed in relation to anatomic location (percentages).
- Fig 4.
Clinical management and treatment procedures in 77 children with intracranial aneurysms.
- Fig 5.
Progressive enlargement of a saccular paraophthalmic aneurysm superimposed on fusiform internal carotid vasculopathy. A, Right ICA angiogram of a patient at age 10, anteroposterior projection demonstrating a tortuous ICA with a superimposed 3-mm saccular paraophthalmic aneurysm (arrow). The patient underwent conservative observation with annual MR angiography which, 4 years later, suggested aneurysm progression. B, Right ICA angiogram of a patient at age 14, anteroposterior projection, demonstrating interval enlargement of the paraophthalmic aneurysm (arrow) to 13 mm, prompting a decision in favor of treatment. C and D, Right ICA angiogram, anteroposterior projection (C), and 3D rotational angiogram (D) of patient at age 14 immediately following successful stent-assisted coiling of the paraophthalmic aneurysm (arrowheads indicate coil mass).
- Fig 6.
Development of a de novo fusiform vertebrobasilar junction aneurysm 3 years after treatment of a fusiform ICA aneurysm with balloon takedown of the ICA in an adolescent male patient. A, Left ICA angiogram of the patient at age 11, lateral projection. B, Vertebrobasilar angiogram at age 11, anteroposterior projection. The left ICA was successfully occluded with 2 detachable balloons immediately following the angiograms shown in A and B. Three years later an MR angiogram (not shown) suggested a new aneurysm at the vertebrobasilar junction. Conventional angiography was performed, confirming this diagnosis (C and D). C, Vertebrobasilar angiogram at age 14, anteroposteror projection. D, Vertebrobasilar angiogram at age 14, lateral projection.
Tables
Category Specific Comorbidity Traumatic Motor vehicle crash (3), Pedestrian-versus-automobile accident with skull base fractures, prior gunshot wound (2), prior skateboard accident, fall, head trauma not otherwise specified Ischemic Prior insular infarct, prior external-carotid-to-internal carotid artery bypass grafting (2) Vasculopathic Fibromuscular dysplasia Dermatologic PHACE, facial and retinal hemangiomas, vascular birthmark Hormonal Growth hormone deficiency with neuromigrational disorder and Moyamoya syndrome, Seckel syndrome (growth hormone deficiency), Majewski type II dwarfism Hematologic Von Willebrand disease Immunologic AIDS, congenital immunodeficiency, combined immunodeficiency syndrome with cerebral angiodysplasia Cardiovascular Congenital aortic stenosis with endocarditis, tricuspid atresia with Fontan procedure, patent ductus arteriosus Neoplastic Juvenile pilocytic astrocytoma Neurologic Seizure disorder Other syndromic Tuberous sclerosis (2), autosomal dominant polycystic kidney disease, trisomy 21 with endocarditis, hemiatrophy, mitochondrial disorder with optic atrophy, family history of Marfan syndrome * Numbers in parentheses indicate comorbidities present in multiple patients. Note that infection is not listed as a comorbidity; however, patients with immunodeficiency syndromes and patients with endocarditis due to an identified underlying risk factor (eg, congenital aortic stenosis) are listed under their primary comorbid condition.
Age at First Presentation (yr) Sex Index Aneurysm First Treatment Time to De Novo or Enlarging Aneurysm De Novo or Enlarging Aneurysm Location Clinical Result Comorbidity 11 M ICA fusiform ICA balloon occlusion 3 yr VB junction fusiform Successful clipping Vascular birthmark 7 M ICA fusiform ICA balloon-coil occlusion 3 yr Intracranial vertebral fusiform Untreatable Hemiatrophy 15 F ICA, MCA, ACA fusiform giant Bypass, trapping 12 yr AcomA fusiform Wrapping, completion coiling None 8 M ACA giant mycotic Coiling 20 mo VB fusiform Died from SAH AIDS 17 F 10 saccular aneurysms Clip 6 ipsilateral; coil 1 contralateral 6 mo Enlarging saccular PcomA Successful coiling Majewski type II dwarfism 10 F Long-segment fusiform ICA Observation 4 yr Enlarging saccular ICA aneurysm Successful stent coiling Tricuspid atresia after Fontan procedure Note:—VB indicates vertebrobasilar; ICA, internal carotid artery; MCA, middle cerebral artery; ACA, anterior cerebral artery; AcomA, anterior communicating artery; PcomA, posterior communicating artery; SAH, subarachnoid hemorrhage.
Series Current Lasjaunias et al18 Huang et al22 Agid et al29 Patients (No.) 77 (103 aneurysms) 59 (75 aneurysms) 706 33 (37 aneurysms) Etiology/morphology Fusiform 31% 56% – 19% Saccular 46% 27% – 46% Infectious 12% 14% – 8% Traumatic 14% 3% – 14% Giant (>25 mm) 11% – 20% – Multiple 16% of patients, 38% of aneurysms 15% – – Posterior circulation 22% 27% 17% 24% Age 12 yr (3 mo to 18 y) 7.6 yr (8 days to 15 yr) 0–18 yr 10.2 y (1 day to 17 yr) Sex (% male) 48% 59% 63% 48% Hemorrhage 32% 54% 80% 27% Mortality 1.3% 10.4% 28% 15% Note:— –indicates not applicable.
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