Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France.
Department of Neurosurgery, Caen University Hospital, Caen, France.
Childs Nerv Syst. 2021 Aug;37(8):2567-2575. doi: 10.1007/s00381-021-05151-6. Epub 2021 Apr 20.
Intracranial aneurysms (IA) in children are rare, accounting for less than 5% of all IA. Due to their scarcity, the epidemiology is poorly understood and differs from adults in term of clinical presentation, size, location, and origin. Consequently, the treatment strategies are specific and cannot be only based on data from adult series. The aim of our study was to report the characteristics, management, and outcomes of children treated for IA in two university hospitals located in Normandy (France) over the last 17 years and to perform a literature review of this rare pathology.
This retrospective study included 18 consecutive children (< 18 years old) admitted with cerebral aneurysm treated in two neurosurgery departments in Normandy, from 2001 to 2018. Computerized tomography and cerebral angiography established the diagnosis. Both endovascular and surgical procedures were discussed in all cases. Data focused on clinical condition at admission, characteristics of the IA, choice of the treatment modalities, and complications. The outcome at follow-up is based on Glasgow outcomes scale (GOS) at 1 year.
During the study period, 18 children (mean age: 12.6 years; sex ratio male/female: 2.3) were admitted with 21 IA. Aneurysms had a mean size of 13.6 mm with 4 giant aneurysms and were mostly located in the anterior circulation (16/21). Clinical presentations at onset were sudden symptoms related to a subarachnoid hemorrhage in 13 patients, headaches in 4 patients with giant aneurysm, and asymptomatic in one patient. Among the 13 patients with ruptured IA, 6 presented in poor preoperative condition (Hunt and Hess Grade ≥ 4). Treatment modalities consisted in embolization in 9 patients and surgery in 9 patients including 2 by-pass surgeries in fusiform aneurysms. Complications were similar in the two groups, but two cases of recanalization were observed in the endovascular group. At 1 year of follow-up, 14 children were in good condition (GOS Score > 4) and one died. Three children presented associated IA treated by the same technique as initial aneurysm.
Pediatric aneurysm is a different pathology compared with adults, occurring more frequently in male population with a higher proportion of giant aneurysms and aneurysms located in the internal carotid bifurcation. The use of endovascular techniques has progressed in the last years, but surgery was proposed for half of our population.
颅内动脉瘤（IA）在儿童中较为少见，占所有 IA 的比例不足 5%。由于其罕见性，其流行病学情况了解甚少，且与成人在临床表现、大小、位置和起源方面存在差异。因此，治疗策略具有特异性，不能仅基于成人系列的数据。本研究的目的是报告过去 17 年在诺曼底（法国）的两所大学医院治疗的儿童颅内动脉瘤患者的特征、治疗方法和结局，并对该罕见疾病进行文献回顾。
这是一项回顾性研究，纳入了 2001 年至 2018 年期间在诺曼底的两个神经外科部门收治的 18 例接受颅内动脉瘤治疗的连续儿童（<18 岁）。计算机断层扫描和脑血管造影术确立了诊断。所有病例均讨论了血管内和手术治疗方法。数据重点关注入院时的临床状况、IA 的特征、治疗方式的选择以及并发症。随访时的结局基于 1 年时的格拉斯哥结局量表（GOS）。
在研究期间，18 例儿童（平均年龄：12.6 岁；男女比例：2.3）因 21 个颅内动脉瘤入院。动脉瘤的平均大小为 13.6mm，其中 4 个为巨大动脉瘤，主要位于前循环（16/21）。起病时的临床表现为 13 例与蛛网膜下腔出血相关的突发症状、4 例巨大动脉瘤相关的头痛以及 1 例无症状。在 13 例破裂的颅内动脉瘤患者中，6 例患者术前情况较差（Hunt 和 Hess 分级≥4）。治疗方式包括栓塞治疗 9 例和手术治疗 9 例，其中 2 例梭形动脉瘤患者采用旁路手术。两组并发症相似，但血管内治疗组有 2 例再通。1 年后，14 例患儿状况良好（GOS 评分>4），1 例死亡。3 例患儿伴有颅内动脉瘤，采用与初始动脉瘤相同的技术治疗。
与成人相比，儿科动脉瘤是一种不同的疾病，男性发病率较高，且更常发生巨大动脉瘤和颈内动脉分叉部动脉瘤。近年来，血管内技术的应用有所进展，但我们的一半患者仍建议采用手术治疗。
