Pediatric intracranial aneurysms

Durability of treatment following microsurgical and endovascular management

Nader Sanai, Alfredo Quinones-Hinojosa, Nalin M. Gupta, Victor Perry, Peter P. Sun, Charles B. Wilson, Michael T. Lawton

Research output: Contribution to journalArticle

Abstract

Object. Longer life expectancies and differences in the underlying disease in children with aneurysms raise important issues concerning the choice of microsurgical or endovascular therapy. The authors reviewed their experience at one institution regarding patients treated between 1977 and 2003, focusing on the issue of treatment durability. Methods. Forty-three aneurysms in 32 pediatric patients were identified. The patients ranged in age from 2 months to 18 years (mean 11.7 years). Only seven patients (22%) presented with subarachnoid hemorrhage, and in nine patients (28%) significant medical comorbidities were present. Aneurysm locations included the internal carotid artery (13 lesions), middle cerebral artery (11 lesions), and the basilar artery/vertebrobasilar junction (six lesions). Of the 43 lesions, 17 (40%) were giant aneurysms and 22 (51%) exhibited fusiform/dolichoectatic morphological features. Thirteen patients underwent microsurgery, 16 endovascular treatment, and three observation. Complete aneurysm obliteration rates were 94 and 82% in the microsurgical and endovascular groups, respectively. There were no deaths in either group, and neurological morbidity rates were comparable. Over time, 14% of endovascularly treated aneurysms recurred, and in 19% of these patients de novo aneurysms developed (mean follow-up duration 5.7 years). In contrast, there were no recurrences in the microsurgically treated aneurysms and only one de novo aneurysm (6%). Conclusions. Both microsurgical and endovascular therapies can be conducted safely to treat pediatric aneurysms. Microsurgery may be more efficacious in completely eliminating the aneurysm and its effects more durable over the extended lifetime of these patients. Parental biases toward nonoperative therapy should be thoroughly addressed before ultimately selecting a treatment strategy.

Original languageEnglish (US)
Pages (from-to)82-89
Number of pages8
JournalJournal of Neurosurgery
Volume104 PEDIATRICS
Issue numberSUPPL. 2
StatePublished - Feb 2006
Externally publishedYes

Fingerprint

Intracranial Aneurysm
Aneurysm
Pediatrics
Therapeutics
Microsurgery
Basilar Artery
Middle Cerebral Artery
Internal Carotid Artery
Subarachnoid Hemorrhage
Life Expectancy
Comorbidity
Observation
Morbidity
Recurrence

Keywords

  • De novo aneurysm
  • Endovascular therapy
  • Intracranial aneurysm
  • Microsurgery
  • Pediatric neurosurgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Sanai, N., Quinones-Hinojosa, A., Gupta, N. M., Perry, V., Sun, P. P., Wilson, C. B., & Lawton, M. T. (2006). Pediatric intracranial aneurysms: Durability of treatment following microsurgical and endovascular management. Journal of Neurosurgery, 104 PEDIATRICS(SUPPL. 2), 82-89.

Pediatric intracranial aneurysms : Durability of treatment following microsurgical and endovascular management. / Sanai, Nader; Quinones-Hinojosa, Alfredo; Gupta, Nalin M.; Perry, Victor; Sun, Peter P.; Wilson, Charles B.; Lawton, Michael T.

In: Journal of Neurosurgery, Vol. 104 PEDIATRICS, No. SUPPL. 2, 02.2006, p. 82-89.

Research output: Contribution to journalArticle

Sanai, N, Quinones-Hinojosa, A, Gupta, NM, Perry, V, Sun, PP, Wilson, CB & Lawton, MT 2006, 'Pediatric intracranial aneurysms: Durability of treatment following microsurgical and endovascular management', Journal of Neurosurgery, vol. 104 PEDIATRICS, no. SUPPL. 2, pp. 82-89.
Sanai N, Quinones-Hinojosa A, Gupta NM, Perry V, Sun PP, Wilson CB et al. Pediatric intracranial aneurysms: Durability of treatment following microsurgical and endovascular management. Journal of Neurosurgery. 2006 Feb;104 PEDIATRICS(SUPPL. 2):82-89.
Sanai, Nader ; Quinones-Hinojosa, Alfredo ; Gupta, Nalin M. ; Perry, Victor ; Sun, Peter P. ; Wilson, Charles B. ; Lawton, Michael T. / Pediatric intracranial aneurysms : Durability of treatment following microsurgical and endovascular management. In: Journal of Neurosurgery. 2006 ; Vol. 104 PEDIATRICS, No. SUPPL. 2. pp. 82-89.
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abstract = "Object. Longer life expectancies and differences in the underlying disease in children with aneurysms raise important issues concerning the choice of microsurgical or endovascular therapy. The authors reviewed their experience at one institution regarding patients treated between 1977 and 2003, focusing on the issue of treatment durability. Methods. Forty-three aneurysms in 32 pediatric patients were identified. The patients ranged in age from 2 months to 18 years (mean 11.7 years). Only seven patients (22{\%}) presented with subarachnoid hemorrhage, and in nine patients (28{\%}) significant medical comorbidities were present. Aneurysm locations included the internal carotid artery (13 lesions), middle cerebral artery (11 lesions), and the basilar artery/vertebrobasilar junction (six lesions). Of the 43 lesions, 17 (40{\%}) were giant aneurysms and 22 (51{\%}) exhibited fusiform/dolichoectatic morphological features. Thirteen patients underwent microsurgery, 16 endovascular treatment, and three observation. Complete aneurysm obliteration rates were 94 and 82{\%} in the microsurgical and endovascular groups, respectively. There were no deaths in either group, and neurological morbidity rates were comparable. Over time, 14{\%} of endovascularly treated aneurysms recurred, and in 19{\%} of these patients de novo aneurysms developed (mean follow-up duration 5.7 years). In contrast, there were no recurrences in the microsurgically treated aneurysms and only one de novo aneurysm (6{\%}). Conclusions. Both microsurgical and endovascular therapies can be conducted safely to treat pediatric aneurysms. Microsurgery may be more efficacious in completely eliminating the aneurysm and its effects more durable over the extended lifetime of these patients. Parental biases toward nonoperative therapy should be thoroughly addressed before ultimately selecting a treatment strategy.",
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AU - Sun, Peter P.

AU - Wilson, Charles B.

AU - Lawton, Michael T.

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