Anatomy, Characteristics, and Management of Pediatric Aneurysms

Pediatric intracranial aneurysms (PIAs) are rarely reported in the literature, their incidence being estimated between 0.5% and 5% according to geographic location as well as diagnostic and management options available. Most often, clinical diagnosis results either from the acute symptomology brought upon by intracranial hemorrhage, or a progressive symptomology in the context of mass effect from giant aneurysms. Unlike adults, wherein the female sex is considered a risk factors, PIAs are more common in males. Although there is a propensity for the anterior circulation, posterior circulation PIAs have a higher proportion than those of adults. Another peculiarity of PIAs is the larger number of giant and dissecting aneurysms, suggesting congenital defects of the arterial wall, all the more evident when these lesions appear within the first year of life. Alongside genetic factors that contribute to these defects, infections and trauma also play a role in the development of PIAs. Their management raises a series of issues, especially in young children whose vessels have smaller diameters. If after 4 years the endovascular treatment is relatively safe, before this age surgery seems the more feasible option. Nevertheless, the treatment of giant or dissecting PIAs is made difficult by the small size of the parent vessels, as well as the lower experience of treating surgeons. Clinical and imagistic observation may be acceptable for selected cases. Considering all technical, surgical, and endovascular challenges, the results and prognostic of hemorrhagic PIAs are better than for ruptured aneurysms in adults, justifying the efforts for the complex treatment of this pathology.