Fulkerson Daniel H, Voorhies Jason M, Payner Troy D, Leipzig Thomas J, Horner Terry G, Redelman Kathleen, Cohen-Gadol Aaron A
Department of Neurosurgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana 46202-5200, USA.
J Neurosurg Pediatr. 2011 Jul;8(1):79-89. doi: 10.3171/2011.4.PEDS10583.
Pediatric intracranial aneurysms are rare lesions that differ from their adult counterparts. Aneurysms involving the middle cerebral artery (MCA) are particularly challenging to treat in children, as they are often fusiform and cannot undergo direct clipping alone. The authors recently treated a patient with a heavily calcified, dysplastic, left-sided MCA aneurysm. The present study was performed to evaluate the authors' previous operative and follow-up experience with these difficult lesions.
The authors performed a review of a prospectively maintained database of all aneurysms treated at Methodist Hospital in Indianapolis, Indiana, from January 1990 through November 2010. Relevant operative notes, clinical charts, and radiological reports were reviewed for all patients 18 years of age or younger.
A total of 2949 patients with aneurysms were treated over the study period, including 28 children (0.95%). Seven children harbored MCA aneurysms. Five of these 7 aneurysms (71.4%) were fusiform. Two patients were treated with direct clipping, 2 underwent parent vessel occlusion without bypass, and 3 underwent aneurysm trapping with extracranial-intracranial vessel bypass. Long-term follow-up data were available in 6 cases. All 6 patients had a 1-year follow-up Glasgow Outcome Scale score of 5. Long-term radiological follow-up was available in 4 patients. One patient required a reoperation for a recurrent aneurysm 4 years after the initial surgery.
Middle cerebral artery aneurysms in children are often fusiform, giant, and incorporate the origins of proximal artery branches. Direct clipping may not be possible; trapping of the lesion may be required. Children seem to tolerate surgical trapping with or without bypass extremely well. Aggressive therapy of these rare lesions in children is warranted, as even patients presenting with a poor clinical grade may have excellent outcomes. Long-term surveillance imaging is necessary because of the risk of aneurysm recurrence.
小儿颅内动脉瘤是罕见病变，与成人颅内动脉瘤不同。累及大脑中动脉（MCA）的动脉瘤在儿童中治疗尤其具有挑战性，因为它们通常呈梭形，无法单独进行直接夹闭。作者最近治疗了一名患有严重钙化、发育异常的左侧MCA动脉瘤患者。本研究旨在评估作者此前对这些疑难病变的手术及随访经验。
作者回顾了1990年1月至2010年11月在印第安纳州印第安纳波利斯市卫理公会医院治疗的所有动脉瘤的前瞻性维护数据库。对所有18岁及以下患者的相关手术记录、临床图表和放射学报告进行了回顾。
在研究期间共治疗了2949例动脉瘤患者，其中包括28名儿童（0.95%）。7名儿童患有MCA动脉瘤。这7例动脉瘤中有5例（71.4%）为梭形。2例患者接受了直接夹闭治疗，2例在未进行搭桥的情况下接受了供血动脉闭塞，3例接受了颅外-颅内血管搭桥的动脉瘤夹闭术。6例患者有长期随访数据。所有6例患者1年随访时格拉斯哥预后量表评分为5分。4例患者有长期放射学随访资料。1例患者在初次手术后4年因复发性动脉瘤需要再次手术。
儿童大脑中动脉动脉瘤常为梭形、巨大型，并累及近端动脉分支的起源。可能无法进行直接夹闭；可能需要对病变进行夹闭术。儿童似乎对有或无搭桥的手术夹闭耐受性非常好。对儿童这些罕见病变进行积极治疗是必要的，因为即使是临床分级较差的患者也可能有良好的预后。由于动脉瘤复发风险，长期监测成像很有必要。
