Multimodal Treatment of Intracranial Aneurysms in Children: Clinical Case Series and Review of the Literature

Background: The management of intracranial aneurysms in the pediatric population presents unique challenges. Cases are rare and tend to be of higher complexity compared with aneurysms in adults. Outcomes in long-term follow-up are not well-characterized. Here we present illustrative case examples to demonstrate key concepts in managing these lesions in the context of the modern neurovascular era. Methods: Four institutional databases of neurovascular procedures from 2012 to 2017 were reviewed. Patients <18 years old who underwent treatment for intracranial aneurysms were included. Patient characteristics, aneurysm details, treatment information, and angiographic and clinical outcomes were recorded. Results: Ten cases of intracranial aneurysms in 9 children were identified. Management included direct clipping, trapping and bypass, endovascular coil embolization, endovascular vessel sacrifice, and flow diversion. Conclusions: The management of intracranial aneurysms in pediatric patients requires special considerations, from the diagnostic phase to treatment methods and follow-up regimen. These are ideally considered by a multidisciplinary team, with expertise from pediatric neurosurgeons, cerebrovascular neurosurgeons, and neurointerventionalists.