Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Department of Neurological Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Oper Neurosurg (Hagerstown). 2019 Nov 1;17(5):E224-E228. doi: 10.1093/ons/opz002.
Flow diversion of intracranial aneurysms has been rarely described in the pediatric population. Here we discuss the technical and perioperative complexities inherent in the flow diversion of an infectious basilar apex aneurysm in a 2-yr-old child with significant medical comorbidities.
Following judicious oral administration of dual anti-platelet agents and intra-arterial administration of calcium channel blockers to treat vasospasm, standard endovascular procedures were used to place a flow diverting stent across the neck of a rapidly enlarging infectious aneurysm of the basilar apex.Following the uncomplicated procedure, the patient demonstrated progressive thrombosis of the previously noted basilar apex aneurysm over a 3-mo period. The patient was therefore felt to be safe to proceed with, and eventually underwent, uncomplicated orthotopic heart transplant.
Flow diversion of complex intracranial aneurysms in pediatric patients with significant medical comorbidities is feasible and safe; however, considerations have to be made in the pre- and perioperative care of these patients given the propensity for low-weight and complicated systemic disease processes.
颅内动脉瘤的血流转向在儿科人群中很少被描述。在这里，我们讨论了在一名存在严重合并症的 2 岁儿童中，对基底动脉尖部感染性动脉瘤进行血流转向所涉及的技术和围手术期复杂性。
在谨慎地口服双联抗血小板药物和动脉内给予钙通道阻滞剂治疗血管痉挛后，采用标准的血管内程序在快速增大的感染性基底动脉尖部动脉瘤的颈部放置了一个血流转向支架。在这个简单的手术后，患者在 3 个月的时间内出现了先前基底动脉尖部动脉瘤的进行性血栓形成。因此，认为患者可以安全地进行，最终进行了简单的原位心脏移植。
对于存在严重合并症的儿科患者，复杂颅内动脉瘤的血流转向是可行且安全的；然而，鉴于低体重和复杂的系统性疾病过程的倾向，必须在这些患者的术前和围手术期护理中进行考虑。
