Kahn Max, Deshpande Girish, Russell Thomas, Lin Julian, Klopfenstein Jeff
Departments of1Neurosurgery and.
2Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois.
J Neurosurg Case Lessons. 2022 Jan 31;3(5). doi: 10.3171/CASE21435.
Reports of ruptured neonatal aneurysms are rare in neurosurgical literature. Pediatric aneurysms differ from adult aneurysms, notably in morphology, size, number, and risk of rerupture. Many authors report experience with clipping, citing durability and decreased use of radiation as benefits over endovascular intervention. Few authors report extracranial-to-intracranial bypass because small pediatric vessels make this option challenging. The authors discussed a case of a newborn with multiple ruptured aneurysms, one of the youngest reported cases involving extracranial-intracranial bypass.
A 3-week-old baby presented with hemorrhage from multiple complex middle cerebral artery (MCA) aneurysms. Because of young age, endovascular intervention was not possible; therefore, the patient received craniotomy. Upon exploration, clip reconstruction was impossible; the vessel was trapped, and superficial temporal artery (STA)-MCA bypass was performed. The recipient vessel diameter was 0.3 mm. The postoperative course was complicated by seizures as well as symptomatic vasospasm, which was treated with intraarterial verapamil and ventriculostomy. At last follow-up, the patient was developing normally and was ambulatory with minimal deficit.
This case, one of the youngest patients reported, highlighted details of pediatric aneurysm management, such as propensity for multiple/fusiform aneurysms and high risk of re-hemorrhage, with significant mortality. The authors recommended aggressive, early intervention in pediatric aneurysms at centers with surgeons familiar with both endovascular intervention and cerebral bypass.
新生儿动脉瘤破裂的报道在神经外科文献中较为罕见。小儿动脉瘤与成人动脉瘤不同，尤其是在形态、大小、数量和再破裂风险方面。许多作者报告了夹闭术的经验，认为与血管内介入相比，夹闭术具有耐久性且减少了辐射使用等优点。很少有作者报告颅外 - 颅内搭桥术，因为小儿血管细小，使这种选择具有挑战性。作者讨论了一例患有多发性破裂动脉瘤的新生儿病例，这是报道的涉及颅外 - 颅内搭桥术的最年幼病例之一。
一名3周大的婴儿因多条复杂的大脑中动脉（MCA）动脉瘤出血就诊。由于年龄小，无法进行血管内介入；因此，患者接受了开颅手术。术中发现无法进行夹闭重建；血管受压，遂进行了颞浅动脉（STA）-MCA搭桥术。受体血管直径为0.3毫米。术后病程出现癫痫发作以及症状性血管痉挛等并发症，通过动脉内注射维拉帕米和脑室造瘘术进行治疗。在最后一次随访时，患者发育正常，可走动，仅有轻微功能缺损。
该病例是报道的最年幼患者之一，突出了小儿动脉瘤治疗的细节，如多发性/梭形动脉瘤的倾向和再出血的高风险，且死亡率较高。作者建议在有熟悉血管内介入和脑搭桥手术的外科医生的中心，对小儿动脉瘤进行积极、早期的干预。
