Intracranial arterial aneurysms in children and adolescents.

This is a report on 32 patients with subarachnoid haemorrhage caused by rupture of an intracranial arterial aneurysm in the 0-19 age group. Sixteen of the aneurysms were situated in the bifurcation of the internal carotid artery, 8 in the anterior communicating artery, 4 in the posterior communicating artery, two in PICA, one in the middle cerebral artery, and one in the pericallosal artery. Direct intracranial clipping of the neck of the aneurysm was carried out in 26 cases, proximal clipping in three, wrapping in two, and common carotid ligation in one case. There was one death from surgery. The surgical mortality was thus 3.1%. In 80% of cases the result was good, i.e., the patient had no neurological deficit and was able to work or continue at normal school. The psychological tests indicated some cognitive deficits in aneurysm patients as compared to the control patients. The common feature of these deficits seemed to be an impairment of active retrieval and searching of memory, while common cognitive skills were usually preserved. Four of the five patients who were disabled had obvious deficits in their performances. In the other patients these deficits did not affect their capacity for work or studies, and they were usually unaware of them. Children seem to tolerate surgery better than adults. Comatose or drowsy patients should not be operated on. The operative method of choice is direct intracranial clipping of the neck of the aneurysm.