Abstract
An intracranial aneurysm in a child or adolescent is a rare, but potentially devastating condition. As little as approximately 1200 cases are reported between 1939 and 2011, with many of the reports presenting diverting results. There is consensus, though, in that pediatric aneurysms represent a pathophysiological entity different from their adult counterparts. In children, there is a male predominance. About two-thirds of pediatric intracranial aneurysms become symptomatic with hemorrhage and the rate of re-hemorrhage is higher than in adults. The rate of hemorrhage from an intracranial aneurysm peaks in girls around menarche. The most common aneurysm site in children is the internal carotid artery, in particular at its terminal ending. Aneurysms in the posterior circulation are more common in children than adults. Children more often develop giant aneurysms, and may become symptomatic from the mass effect of the aneurysm (tumorlike symptoms). The more complex nature of pediatric aneurysms poses a larger challenge to treatment alongside with higher demands to the durability of treatment. Outcome and mortality are similar in children and adults, but long-term outcome in the pediatric population is influenced by the high rate of aneurysm recurrences and de novo formation of intracranial aneurysms. This urges the need for life-long follow-up and screening protocols.
Highlights
Intracranial aneurysms occur rarely in children and adolescents
The present review focuses on intracranial pediatric aneurysms of non-traumatic origin as the latter are pseudoaneurysms caused by endothelial damage and thereby form a different pathofysiological entity
By reviewing 431 reported cases [7, 8, 11, 13, 16,17,18,19,20,21,22,23,24,25,26,27,28,29], we found that 17% of the children presented with neurological deficits and/or epilepsy, whereas in another 8% the aneurysm was found in the diagnostic work-up for chronic headaches
Summary
Intracranial aneurysms occur rarely in children and adolescents. the literature on intracranial aneurysms in individuals younger than 18 years is limited and to some degree inconsistent, there seems to be consent in that pediatric aneurysms represent an independent condition different to their adult counterparts. Some authors found that children with aneurysmal intracranial hemorrhage more often present in a good clinical grade (Hunt and Hess grades 1-3, [43]) than adults [7, 8, 19, 20, 33, 26, 27, 44]. Reviewing 671 pediatric cases reported in the literature [7, 8, 11, 13, 16,17,18,19,20,21,22,23,24,25,26,27,28,29, 33, 36, 37, 39, 40, 44, 46], 16% of all pediatric aneurysms occur at the ICA termination alone (Fig. 5), which compares to around only 5% in adults
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