Cerebral aneurysms in childhood and adolescence

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✓ In this study, 24 aneurysms occurring in 23 patients under the age of 18 years (mean 12 years) are analyzed. The male:female ratio was 2.8:1, and the youngest patient was 3 months old. Mycotic lesions and those associated with other vascular malformations were excluded. Forty-two percent of the aneurysms were located in the posterior circulation, and 54% were giant aneurysms. Presenting symptoms included subarachnoid hemorrhage in 13 and mass effect in 11. Several of these aneurysms were documented to rapidly increase in size over a 3-month to 2-year period of observation. All aneurysms were surgically treated: direct clipping was performed in 14; trapping with bypass in four; trapping alone in four; and direct excision with end-to-end anastomosis in two. The postoperative results were excellent in 21 aneurysms (87%), good in two (8%), and poor in one. The pathogenesis of cerebral aneurysms is reviewed.

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Address reprint requests to: Fredric B. Meyer, M.D., Department of Neurosurgery, Mayo Clinic, 200 First Street S. W., Rochester, Minnesota 55905.

© AANS, except where prohibited by US copyright law.

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    Case 1. Left: Contrast-enhanced computerized tomography scan demonstrating a 1-cm lesion in the mesial left temporal lobe. This has a typical appearance of aneurysms in this location with a contrast layer within a lumen surrounded by a peripheral rim without significant mass effect. In spite of this, conservative treatment was recommended. Right: Angiogram demonstrating a 3-cm giant aneurysm of the P2 segment of the posterior cerebral artery. This was treated by direct clipping of aneurysm neck.

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    Case 2. Photomicrograph of the aneurysm neck showing fragmentation and nearly total absence of both the internal elastic membrane (straight arrow) and muscularis layer (curved arrow), thickened intima (I), and adventitia with reactive fibrosis (A). ElVG, × 70.

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    Case 3. Left: Angiogram demonstrating a giant aneurysm of the internal carotid artery extending from the sphenoid sinus to the bifurcation. Right: Angiogram obtained after the carotid aneurysm was treated by cervical internal carotid artery ligation. Protection of hemispheric blood flow was insured through a superficial temporal-middle cerebral artery bypass. Intraoperative cerebral blood flow measured 40 ml/100 gm/min through the graft.

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    Case 3. Upper Left: Left vertebral angiogram obtained during evaluation of the giant carotid aneurysm demonstrating mild irregularity and dilatation of both the vertebral and basilar arteries. Upper Right and Lower Left: Angiograms obtained 2 years later demonstrating progression of the basilar dilatation into a giant bilobed aneurysm. The patient tolerated a 10-minute trial balloon-occlusion of the vertebral artery due to collateral flow from a patent left posterior communicating artery. The base of the aneurysm was clipped from a suboccipital approach with preservation of the left anterior inferior cerebellar artery. Lower Right: Postoperative angiogram demonstrating obliteration of the aneurysm. The patient awoke with a mild hemiparesis which improved over the next 10 days. Upon discharge, the patient's only deficit was a mild decrease in manual dexterity.

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