Shirani Peyman, Mirbagheri Saeedeh, Shapiro Maksim, Raz Eytan, Mowla Ashkan, Semsarieh Bita, Riina Howard A, Nelson Peter K
Department of Neurology/Rehabilitation Medicine and Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA.
Department of Diagnostic Radiology, Mount Sinai Beth Israel Medical Center, New York, New York, USA.
Interv Neurol. 2020 Jan;8(2-6):101-108. doi: 10.1159/000496291. Epub 2019 Feb 15.
Pediatric intracranial aneurysms tend to differ in etiology, size, and location from their adult counterparts, and they are often less amenable to microsurgical clip reconstruction techniques. Endovascular treatment with detachable coils is an accepted treatment technique for pediatric patients, though high recurrence rates have been reported with coil embolization of large and giant aneurysms in this population. While the Pipeline Embolization Device (PED) is FDA-approved for adult intracranial aneurysms, the use of PEDs in pediatric patients is considered off-label.
We present 3 cases of pediatric intracranial aneurysms in a 5-year-old male, a 12-year-old male, and a 12-year-old female who presented with symptoms including seizure, headache, and blurred vision. The 2 male patients were found to have intradural vertebral artery saccular aneurysms, while the female patient had a paraophthalmic right internal carotid complex aneurysm. After endovascular reconstruction of the aneurysms with PEDs, follow-up angiography showed complete occlusion of the previous aneurysms with no residual aneurysm filling in all 3 cases.
While further investigation is needed, the evidence presented here supports the conclusion that the PED can be an effective and viable treatment strategy in the pediatric population.
小儿颅内动脉瘤在病因、大小和位置上往往与成人不同，而且通常不太适合采用显微外科夹闭重建技术。可脱卸弹簧圈血管内治疗是小儿患者公认的治疗技术，不过据报道，该人群中大型和巨大动脉瘤采用弹簧圈栓塞的复发率较高。虽然管道栓塞装置（PED）已获美国食品药品监督管理局（FDA）批准用于成人颅内动脉瘤，但在小儿患者中使用PED被视为超适应证使用。
我们报告了3例小儿颅内动脉瘤病例，分别为一名5岁男性、一名12岁男性和一名12岁女性，他们的症状包括癫痫发作、头痛和视力模糊。两名男性患者被发现患有硬脊膜内椎动脉囊状动脉瘤，而女性患者患有眼旁右侧颈内动脉复合动脉瘤。在用PED对动脉瘤进行血管内重建后，随访血管造影显示所有3例先前的动脉瘤均完全闭塞，无残余动脉瘤显影。
虽然还需要进一步研究，但此处提供的证据支持以下结论：PED在小儿人群中可以是一种有效且可行的治疗策略。
