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Richard C. E. Anderson, Michael M. McDowell, Christopher P. Kellner, Geoffrey Appelboom, Samuel S. Bruce, Ivan S. Kotchetkov, Raqeeb Haque, Neil A. Feldstein, E. Sander Connolly Jr., Robert A. Solomon, Philip M. Meyers, and Sean D. Lavine

A rteriovenous malformations are one of the major causes of stroke in children. 1 , 4–6 Because intracerebral hemorrhage is the most devastating as well as the most common clinical presentation (46%–87%) in children with AVMs, there is a strong interest in establishing treatment strategies that could prevent or reduce both the initial hemorrhage and possible rebleeding. 7 , 9 , 11 , 14 , 15 , 17 Aneurysms separate and distinct from the circle of Willis are commonly found located adjacent to or within AVMs, and are typically classified as either arterial

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M. Yashar S. Kalani, Ali M. Elhadi, Wyatt Ramey, Peter Nakaji, Felipe C. Albuquerque, Cameron G. McDougall, Joseph M. Zabramski, and Robert F. Spetzler

T he incidence of aneurysms in the pediatric population is not well established, but several studies suggest that between 1% and 5% of all aneurysms occur in children. 3 , 5 , 7 , 8 , 13–15 It is speculated that the etiology of aneurysm formation in children may be different than in adults, as a disproportionate number of pediatric aneurysms are large to giant and fusiform or dissecting. 5 , 8 , 14 These characteristics of pediatric aneurysms make them challenging for standard microsurgical treatment options. Although endovascular techniques are a well

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Suresh N. Magge, H. Isaac Chen, Michael F. Stiefel, Linda Ernst, Ann Marie Cahill, Robert Hurst, and Phillip B. Storm

I ntracranial aneurysms in young children are uncommon. They can be associated with congenital syndromes, such as Ehlers–Danlos syndrome, pseudoxanthoma elasticum, or coarctation of the aorta. 2 Systemic vasculitides can lead to the formation of systemic aneurysms because inflammation can weaken arterial wall strength. Although aneurysms can form in various vessels, the involvement of intracranial vessels in these diseases is exceedingly rare. We report the case of an 18-month-old girl who initially presented with a ruptured ACoA aneurysm and SAH

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Todd D. Vogel, Charles G. Kulwin, Andrew J. DeNardo, Troy D. Payner, Joel C. Boaz, and Daniel H. Fulkerson

I ntracranial aneurysms are rare in the pediatric population. There are a number of risk factors for aneurysms in children, including neurofibromatosis, connective tissue diseases, and a history of trauma or infection. Radiation therapy has been implicated as a risk factor for aneurysm formation. Radiation-induced aneurysms are rare but are associated with a high mortality rate. 4 , 16 We describe the case of a 16-year-old patient presenting with suspected “tumor bleeding” from a long-standing optic glioma. Further work-up demonstrated a de novo aneurysm

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Anthony C. Wang, Joseph J. Gemmete, Catherine E. Keegan, Cordelie E. Witt, Karin M. Muraszko, Khoi D. Than, and Cormac O. Maher

microcephaly and hydrocephalus. Superficial hemangiomata involving the face and scalp are commonly seen in patients with RBS. The syndrome has not been associated with intracranial aneurysms. We report on a patient with RBS who presented with a spontaneous posterior fossa hemorrhage and multiple, distal, small saccular intracranial aneurysms. Case Report History and Examination This 10-year-old girl with a karyotype-proven diagnosis of RBS had several episodes of emesis at school and was noted to be mildly lethargic. Her level of consciousness deteriorated

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Adam S. Reig, Scott Simon, and Robert A. Mericle

M any endovascular treatments for posttraumatic, high-cervical, skull base aneurysms have been described, 4 , 5 , 11 but embolization with a liquid embolic agent is a new approach that has not been described as an option in this situation. Liquid embolization appears to have the advantage of more complete volumetric filling, reduced recanalization rates, and lower expense compared with coil embolization or stent-assisted coiling. 2 , 8 Ethylene vinyl alcohol copolymer mixed with tantalum and dissolved in dimethyl sulfoxide (Onyx HD 500, ev3 Neurovascular

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Michael J. Ellis, Samuel Cheshier, Sunjay Sharma, Derek Armstrong, Cynthia Hawkins, Eric Bouffet, James T. Rutka, and Michael D. Taylor

fundamental in susceptible patients such as those with NF1. 11 , 30 In addition to neoplastic processes, patients with NF1 are also at risk for several cerebrovascular conditions such as moyamoya syndrome, arterial dissections and stenoses, and intracranial aneurysms. 8 , 28 , 33 Although pediatric aneurysms often differ greatly from their adult counterparts in terms of size, location, and etiology, an increasing number of children are benefitting from endovascular approaches. 1 , 16 , 29 We report on a case of a young girl who presented with subarachnoid hemorrhage

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Osman Ocal, Mustafa Yilmaz, Bora Peynircioglu, Burcak Bilginer, Ahmet Peker, and Anil Arat

A n isolated true aneurysm of the internal carotid artery (ICA) in the pediatric population is extremely rare, with only 10 reported cases in the literature. 1 , 4 , 6 , 8–11 , 14 , 15 , 21 Since there is a risk of cerebral thromboembolism, mass effect, or rarely rupture, treatment is often indicated. 23 In some cases, due to accompanying kinks or loops of the carotid artery, endovascular treatment may be very difficult. With only one exception, all of the reported pediatric cases were treated surgically. To our knowledge, the present case report is the first

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Sean Sullivan, Pedro Aguilar-Salinas, Roberta Santos, Alexandra D. Beier, and Ricardo A. Hanel

neuroendovascular training has been shown to result in shorter fluoroscopy times, better acquisition of roadmaps, and useful angiographic projections. 11 The prevalence of aneurysms in the pediatric population is much lower than in adults, and concepts and tools sometimes have to be adapted from one population to another. Simulation technologies allow neurointerventionalists to practice a procedure in a safe environment before treating a more vulnerable pediatric patient, especially in the setting of a complex vascular lesion. 4 Additionally, the simulation allows the operator

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Päivi Koroknay-Pál, Hanna Lehto, Mika Niemelä, Riku Kivisaari, and Juha Hernesniemi

P ediatric patients with aneurysms differ from adults regarding their clinical presentation, aneurysm morphology, and outcome. 3 , 28 There is a male predominance of these patients, 28 , 38 and aneurysms tend to be larger, 3 with the most common location being the ICA bifurcation. 42 According to the literature, the incidence of cerebral aneurysms in the first 2 decades of life is relatively low, consisting of only 0.5%–7% of all aneurysm patients. 7 , 10 , 28 , 29 , 33 , 34 , 37 , 38 , 40 , 41 , 49 Over the years only a few case reports, smaller