Efficacy of clip-wrapping in treatment of complex pediatric aneurysms

Abstract

Pediatric aneurysms (PAs) are distinct from their adult counterparts with respect to typical location, aneurysm type, and known predisposing risk factors. Many strategies have been employed to treat PAs, but although it has been used frequently in adults, clip wrapping in pediatric patients has only been reported once. We present a series of pediatric patients that underwent clip wrapping and discuss this strategy as an effective means of treating unclippable PAs. Pediatric patients with clip-wrapped aneurysms over a 5-year period were retrospectively identified. Clinical presentation, surgical management, and clinical and radiological outcome of the patients were evaluated. Five pediatric patients with aneurysms were treated with clip wrapping during the specified period. Three had traumatic pseudoaneurysms, with two subarachnoid hemorrhages from aneurysm rupture. One patient presented with mycotic pseudoaneurysm rupture causing a large intraparenchymal and subarachnoid hemorrhage. Another patient had a dissecting complex saccular lenticulostriate aneurysm with four perforating vessels arising from the dome. Four patients had good clinical results, with Glasgow Outcome Scale (GOS) scores of 5 after at least 1-year follow-up (mean 24.2); one patient had a GOS score of 5 at discharge, but no additional follow-up. Postoperative neuroimaging demonstrated vessel patency after clip wrapping with no recurrent hemorrhages or increase in aneurysm size; however, one had progressive occlusion of the artery in a delayed fashion and had a small clinical ischemic event from which she fully recovered. Clip wrapping appears to be an effective underutilized technique for treatment of pediatric complex aneurysms that cannot be treated with conventional methods.