History of surgery for cerebrovascular disease in children. Part I. Intracranial arterial aneurysms

Jeffrey P. Blount M.D., W. Jerry Oakes M.D., R. Shane Tubbs P.A.-C., Ph.D. and Robin P. Humphreys M.D.
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  • Division of Pediatric Neurosurgery, University of Alabama at Birmingham/Children's Hospital of Alabama, Birmingham, Alabama; and the Hospital for Sick Children, University of Toronto, Ontario, Canada
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✓ Intracranial aneurysms are rare in children, and their origins and treatment methods tend to be different from those in these same entities in adults. These lesions tend to be congenital or to have an infectious or traumatic origin. In the current paper the authors trace the historical evolution of the diagnosis and treatment of intracranial aneurysms in children. Based on the literature, these lesions appear to occur in children in less than 3% of all series. The literature also supports the suggestion that symptoms from these aneurysms are often from mass effect and that giant aneurysms and lesions in the posterior cranial fossa are relatively more common in children than in adults. The termination of the carotid artery and the anterior cerebral artery seem to be disproportionately common sites of aneurysm formation in this cohort. Interestingly, surgical outcomes in children appear to be moderately better than in adults. Based on the literature, the claim can be made that a multidisciplinary approach to the management of such aneurysms can yield good outcomes in a very high percentage of children treated.

Abbreviations used in this paper:ACA = anterior cerebral artery; AVM = arteriovenous malformation; CA = carotid artery; CT = computerized tomography; HIV = human immunodeficiency virus; ISAT = International Subarachnoid Aneurysm Trial; MR = magnetic resonance; SAH = subarachnoid hemorrhage.

✓ Intracranial aneurysms are rare in children, and their origins and treatment methods tend to be different from those in these same entities in adults. These lesions tend to be congenital or to have an infectious or traumatic origin. In the current paper the authors trace the historical evolution of the diagnosis and treatment of intracranial aneurysms in children. Based on the literature, these lesions appear to occur in children in less than 3% of all series. The literature also supports the suggestion that symptoms from these aneurysms are often from mass effect and that giant aneurysms and lesions in the posterior cranial fossa are relatively more common in children than in adults. The termination of the carotid artery and the anterior cerebral artery seem to be disproportionately common sites of aneurysm formation in this cohort. Interestingly, surgical outcomes in children appear to be moderately better than in adults. Based on the literature, the claim can be made that a multidisciplinary approach to the management of such aneurysms can yield good outcomes in a very high percentage of children treated.

Abbreviations used in this paper:ACA = anterior cerebral artery; AVM = arteriovenous malformation; CA = carotid artery; CT = computerized tomography; HIV = human immunodeficiency virus; ISAT = International Subarachnoid Aneurysm Trial; MR = magnetic resonance; SAH = subarachnoid hemorrhage.

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Contributor Notes

Address reprint requests to: Jeffrey P. Blount, M.D., Pediatric Neurosurgery, Children's Hospital of Alabama, ACC 400, 1600 Seventh Avenue South, Birmingham, Alabama 35233. email: jeffrey.blount@ccc.uab.edu.

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